TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) DAVE ROZENBOOM........................................................................ CHAIR	2.00 .......................0.00	X	X	0	0	0
(2) MICHAEL BENDER........................................................................ VICE CHAIR	2.00 .......................0.00	X	X	0	0	0
(3) DAVID KAPASKA DO........................................................................ PRESIDENT & CEO	40.00 .......................0.00	X	X	0	796,316	32,081
(4) SISTER JANICE KLEIN........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(5) GENE JONES JR........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(6) AMY KRIE MD........................................................................ BOARD TRUSTEE	40.00 .......................0.00	X		746,760	0	21,157
(7) SISTER KATHRYN EASLEY........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(8) KIM PEDERSON MD........................................................................ BOARD TRUSTEE	40.00 .......................0.00	X		298,963	0	36,933
(9) SISTER JOAN REICHELT........................................................................ BOARD TRUSTEE	2.00 .......................43.80	X		0	0	0
(10) GREG SCHROEDER MD........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(11) FRED THURMAN........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(12) DAVID FLECK........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(13) JAMES WIEDERRICH........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(14) BILL ROSSING MD........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(15) CINDY WALSH........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(16) DAVID CHICOINE........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0
(17) SISTER CANDYCE CHRYSTAL........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X		0	0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) HUGH VENRICK........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X				0	0	0
(19) RAED SULAIMAN MD........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X				0	0	0
(20) CAROL TWEDT........................................................................ BOARD TRUSTEE	2.00 .......................0.00	X				0	0	0
(21) JULIE N NORTON........................................................................ SEC/TREAS & SRVP FINANCE	40.00 .......................0.00		X			391,679	0	45,363
(22) JUDY BLAUWET........................................................................ SR VICE PRESIDENT	40.00 .......................0.00			X		347,006	0	28,136
(23) DAVID FLICEK........................................................................ CHIEF ADMINISTRATIVE OFFICER	1.00 .......................40.00			X		0	531,634	35,637
(24) STEVE PETERSEN........................................................................ AVP-PHARMACY	40.00 .......................0.00			X		195,012	0	33,245
(25) MARY LEEDOM........................................................................ AVP-SURGERY	40.00 .......................0.00			X		180,386	0	12,486
(26) CURT HOHMAN........................................................................ SR VICE PRESIDENT	40.00 .......................0.00			X		286,411	0	27,830
(27) KELLY MCCAUL MD ABIM FRCPC........................................................................ HEMATOLOGY, TRANSPLANTATION	40.00 .......................0.00				X	1,203,726	0	28,630
(28) HENDRICK KLOPPER MD........................................................................ NEUROSURGERY	40.00 .......................0.00				X	1,245,102	0	39,174
(29) BRIAN KNUTSON MD........................................................................ DERMATOLOGY	40.00 .......................0.00				X	1,180,921	0	41,613
(30) MICHAEL PUUMALA MD........................................................................ NEUROSURGERY	40.00 .......................0.00				X	1,221,900	0	39,613
(31) DANIEL TYNAN MD........................................................................ NEUROSURGERY	40.00 .......................0.00				X	1,220,879	0	42,113

(A) Name and business address	(B) Description of services	(C) Compensation
AVERA CENTRAL SERVICES3900 WEST AVERA DRIVESIOUX FALLSSD57108	SHARED SERVICES	36,079,586
SIOUX FALLS CONSTRUCTIONPO BOX 2728SIOUX FALLSSD571072728	CONSTRUCTION	14,216,408
SANFORD SCHOOL OF MEDICINE1400 W 22ND ST 120SIOUX FALLSSD571051505	PHYSICIAN SERVICES	3,169,198
ASSOCIATED REGIONAL & UNIVERSITY PATHOLOPO BOX 27964SALT LAKE CITYUT84127	LAB TESTING	1,883,742
PHYSICIANS LABORATORY LTD1301 S CLIFF AVE SUITE 700SIOUX FALLSSD571051019	PATHOLOGY	1,695,573
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 88

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	3,763,251	3,763,251
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	100,000	100,000
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,660,928	1,551,291	1,109,637
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	537,998	537,998
7	Other salaries and wages	317,761,849	290,793,520	26,559,516	408,813
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	21,327,019	18,942,374	2,357,661	26,984
9	Other employee benefits .......	35,086,855	31,030,581	3,994,914	61,360
10	Payroll taxes ...........	21,203,703	18,985,996	2,188,629	29,078
11	Fees for services (non-employees):
a	Management ......	279,931	279,931
b	Legal .........	268,836	244,914	23,922
c	Accounting ...........	52,577	23,648	28,929
d	Lobbying ...........	35,663		35,663
e	Professional fundraising services. See Part IV, line 17	65,630			65,630
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	112,632,442	57,480,240	55,149,606	2,596
12	Advertising and promotion ....	2,211,059	676,024	1,517,525	17,510
13	Office expenses .......	9,104,931	4,799,978	4,135,537	169,416
14	Information technology ......	7,222,511	597,969	6,624,542
15	Royalties ..
16	Occupancy ...........	21,706,284	15,550,623	6,155,538	123
17	Travel ............	3,265,432	2,823,676	436,975	4,781
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	1,846,239	1,727,377	118,626	236
20	Interest ...........	8,013,346	7,772,173	241,173
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	36,412,828	31,006,917	5,399,191	6,720
23	Insurance ..............	1,517,460	1,525,720	-8,260
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	132,870,447	132,293,360	569,087	8,000
b	BAD DEBT EXPENSE	17,664,754	17,664,754
c	EQUIPMENT LEASE AND REN	3,503,657	1,665,216	1,836,709	1,732
d	UBI TAX	388,712	388,712
e	All other expenses	5,456,194	1,595,013	3,856,557	4,624
25	Total functional expenses. Add lines 1 through 24e	766,960,536	643,821,256	122,331,677	807,603
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	25,389,142	2	24,099,954
3	Pledges and grants receivable, net ...........	2,382,202	3	2,286,327
4	Accounts receivable, net .............	93,735,966	4	106,439,778
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5	54,167
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............	3,220,401	7	3,048,041
8	Inventories for sale or use ..............	14,929,302	8	15,633,019
9	Prepaid expenses and deferred charges ..........	10,595,030	9	16,682,059
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	734,763,682
b	Less: accumulated depreciation .....	10b	379,015,317	358,612,850	10c	355,748,365
11	Investments—publicly traded securities ..........	8,554,927	11	9,884,715
12	Investments—other securities. See Part IV, line 11 .....	229,497,375	12	267,843,176
13	Investments—program-related. See Part IV, line 11 .....	11,817,238	13	12,480,826
14	Intangible assets ...............	45,416,755	14	42,906,869
15	Other assets. See Part IV, line 11 ...........	23,832,489	15	44,080,799
16	Total assets. Add lines 1 through 15 (must equal line 34)......	827,983,677	16	901,188,095
	17	Accounts payable and accrued expenses .........	69,147,875	17	67,459,728
18	Grants payable .................		18
19	Deferred revenue ................	1,464,257	19	495,769
20	Tax-exempt bond liabilities .............	221,217,723	20	246,486,080
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	823,621	21	835,399
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	17,706,579	23	5,652,057
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	31,746,136	25	29,257,633
26	Total liabilities. Add lines 17 through 25.........	342,106,191	26	350,186,666
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	471,655,159	27	534,600,056
28	Temporarily restricted net assets ...........	11,590,650	28	13,708,584
29	Permanently restricted net assets ...........	2,631,677	29	2,692,789
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	485,877,486	33	551,001,429
34	Total liabilities and net assets/fund balances ........	827,983,677	34	901,188,095

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the supported organization? ................

11g(i)

(ii) A family member of a person described in (i) above? ......................

11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization AVERA MCKENNAN

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization AVERA MCKENNAN

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
AVERA MCKENNAN

Employer identification number

46-0224743

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed.

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

See separate instructions. SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2013

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2013

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

35,663

Total. Add lines 1c through 1i ...............................

35,663

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	PART II-B LINE 1G AND 1I: AVERA MCKENNAN PARTICIPATES THROUGH VARIOUS HOSPITAL ORGANIZATIONS TO PROMOTE LEGISLATION THAT WOULD RESULT IN STRENGTHENING HEALTH CARE DELIVERY SYSTEMS ON A NATIONAL, REGIONAL, AND LOCAL LEVEL.

Schedule C (Form 990 or 990EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:

			Amount
c	Beginning balance .................................	1c	20,017
d	Additions during the year ..............................	1d	138,477
e	Distributions during the year .............................	1e	142,980
f	Ending balance ...................................	1f	15,514

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	2,631,677	2,141,642	2,021,909	1,981,042	1,897,334
b	Contributions ........
c	Net investment earnings, gains, and losses	61,112	490,035	119,733	40,867	83,708
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	2,692,789	2,631,677	2,141,642	2,021,909	1,981,042

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	9,816,178	20,412,653		30,228,831
b	Buildings ................	2,279,713	402,616,619	169,317,546	235,578,786
c	Leasehold improvements ............		7,164	478	6,686
d	Equipment ................		272,183,584	203,837,027	68,346,557
e	Other .................		27,447,771	5,860,266	21,587,505
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					355,748,365

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) ASSETS LIMITED AS TO USE - AVERA POOLED INVESTMENTS	226,471,302	F
(B) AVERA HOME MEDICAL EQUIPMENT, LLC	3,621,568	C
(C) HEART HOSPITAL OF SOUTH DAKOTA, LLC	15,673,050	C
(D) INTEREST IN AVERA HEALTH FOUNDATION	15,630,773	F
(E) INVESTMENTS IN AFFILIATED COMPANIES	6,446,483	C




Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	267,843,176

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
OTHER LIABILITIES		2,683,696
DUE TO OTHER ORGANIZATIONS		1,174,897
MARKET VALUE OF INTEREST SWAP		8,578,366
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS		7,715,008
MINORITY INTEREST		4,530,666
INSURANCE LOSS LIABILITY		4,575,000



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		29,257,633
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	901,128,847
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	20,388,653
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	89,521,788
e	Add lines 2a through 2d .....................			2e	109,910,441
3	Subtract line 2e from line 1.....................			3	791,218,406
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b	18,041,832
c	Add lines 4a and 4b.......................			4c	18,041,832
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	809,260,238

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	839,720,650
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	92,320,996
e	Add lines 2a through 2d......................			2e	92,320,996
3	Subtract line 2e from line 1.....................			3	747,399,654
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b	19,560,882
c	Add lines 4a and 4b.......................			4c	19,560,882
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	766,960,536

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART IV, LINE 1B:	THE ORGANIZATION HOLDS FUNDS IN TRUST ON BEHALF OF ITS LONG-TERM CARE RESIDENTS. MANY SMALL DOLLAR TRANSACTIONS FLOW IN AND OUT OF THIS ACCOUNT. THE ACCOUNT IS MANAGED BY THE NURSING HOME STAFF. THE STATE HAS STRICT GUIDELINES ON HOW THESE ACCOUNTS ARE MANAGED.
PART IV, LINE 2B:	THE ORGANIZATION HOLDS AN AMOUNT IN TRUST RELATED TO A NON-COMPETE AS PART OF AN EMPLOYMENT AGREEMENT FOR AN EMPLOYED PHYSICIAN. THE AMOUNT WILL BE HELD AND THEN PAID OUT WHEN THE PHYSICIAN REACHES AGE 65 OR EARLIER ACCORDING TO THE WRITTEN TRUST AGREEMENT.
PART V, LINE 4:	THE ORGANIZATION'S ENDOWMENT CONSISTS OF A PORTION OF THEIR INTEREST IN THE NET ASSETS OF AVERA HEALTH FOUNDATION. THE AVERA HEALTH FOUNDATION INCLUDES ENDOWMENT FUNDS WHICH HAVE BEEN ESTABLISHED FOR A VARIETY OF PURPOSES. AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS (IF ANY), ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. THE ORGANIZATION'S PERMANENTLY RESTRICTED ENDOWMENT FUNDS ARE DONOR RESTRICTED. THE ORGANIZATION CURRENTLY DOES NOT HAVE ANY BOARD DESIGNATED ENDOWMENT FUNDS.
PART X, LINE 2:	THE ORGANIZATION IS ORGANIZED AS A NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). CERTAIN CONSOLIDATED SUBSIDIARIES, INCLUDING AVERA HOME MEDICAL EQUIPMENT LLC, HEART HOSPITAL OF SOUTH DAKOTA LLC, AND ALUMEND LLC, ARE NOT TAX-EXEMPT ENTITIES AND ARE CONSIDERED PARTNERSHIPS OR DISREGARDED ENTITIES FOR TAX PURPOSES. AVERA MCKENNAN IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, AVERA MCKENNAN IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. AVERA MCKENNAN FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. FOR THE YEARS ENDED JUNE 30, 2014 AND 2013, CASH PAID FOR INCOME TAXES WAS $163,712 AND $852,192, RESPECTIVELY. THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES WERE INCURRED. THE ORGANIZATION'S FEDERAL FORM 990T AND OTHER TAX RETURN FILINGS ARE GENERALLY NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	REVENUES OF CONSOLIDATED SUBSIDIARIES CONSOLIDATED FOR FINANCIAL STATEMENTS 109,397,780. OCCUPANCY EXPENSES INCLUDED IN NONOPERATING INCOME ON FINANCIAL STATEMENTS -1,830,498. RECLASS OF LOSSES ON INTEREST RATE SWAPS RECORDED IN N/A FOR TAX RETURN -380,740. BAD DEBT EXPENSE REPORTED IN REVENUE FOR FINANCIAL STATEMENTS -17,664,754.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	INVESTMENT CHG IN AVERA HEALTH FDTN RECORDED IN FD BALANCE ON FINANCIAL STMT 272,347. GAIN FROM INVESTMENT IN SUBSIDIARIES RECORDED IN REVENUE FOR TAX RETURN 10,930,002. MANAGEMENT FEES INCLUDED IN EXPENSES ON FINANCIAL STATEMENTS 1,927,011. RENTAL EXPENSE INCLUDED IN REVENUES ON FINANCIAL STATEMENTS -1,234,325. CONTRIBUTION OF LONG-LIVED ASSET RECORDED IN NET ASSETS FOR FINANCIAL STMT 3,723,567. TEMP & PERM CHANGES IN INVESTMENT OF AVERA FOUNDATION 2,179,046. CHANGE IN NONCONTROLLING INTEREST IN HEART HOSPITAL OF SOUTH DAKOTA 147,304. CONTRIBUTION RECORDED IN EXPENSES FOR FINANCIAL STATEMENT PURPOSES 31,250. PROFESSIONAL FUNDRAISING EXPENSES PROVIDED BY RELATED ORGANIZATION ON F/S 65,630.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	EXPENSES OF CONSOLIDATED SUBSIDIARIES CONSOLIDATED FOR FINANCIAL STATEMENTS 93,044,932. MANAGEMENT FEES INCLUDED IN REVENUE FOR TAX RETURN -1,927,011. RENTAL EXPENSE INCLUDED IN EXPENSES FOR TAX RETURN 1,234,325. CONTRIBUTION RECORDED IN EXPENSES FOR FINANCIAL STATEMENT PURPOSES -31,250.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	OCCUPANCY EXPENSES INCLUDED IN THE NONOPERATING INCOME FOR FINANCIAL STMTS 1,830,498. BAD DEBT EXPENSE REPORTED IN REVENUE FOR FINANCIAL STATEMENTS 17,664,754. PROFESSIONAL FUNDRAISING EXPENSES PROVIDED BY RELATED ORGANIZATION ON F/S 65,630.

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization
AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
			Yes	No
	THEODORE MUENSTER 509 LINDEN AVE VERMILLION, SD57069	MAJOR AND PLANNED GIFT SOLICITATIONS		No	0	0	8,000
	JON OIEN 600 E SUNNYBROOK DR SIOUX FALLS, SD57105	MAJOR AND PLANNED GIFT SOLICITATIONS		No	0	0	57,630








Total .................							65,630

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2013

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

			(a) Event #1 (event type)	(b) Event #2 (event type)	(c) Other events (total number)	(d) Total events (add col. (a) through col. (c))
	1	Gross receipts . . .
	2	Less: Contributions . .
	3	Gross income (line 1 minus line 2) . . .
	4	Cash prizes . . .
	5	Noncash prizes . .
	6	Rent/facility costs . .
	7	Food and beverages .
	8	Entertainment . . .
	9	Other direct expenses .
	10	Direct expense summary. Add lines 4 through 9 in column (d) ...........
	11	Net income summary. Subtract line 10 from line 3, column (d)...........

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2013

Page 3

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..	12,632,663		12,632,663	1.690 %
b	Medicaid (from Worksheet 3, column a) ....	65,020,635	50,980,469	14,040,166	1.870 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .	1,323,973	1,179,084	144,889	0.020 %
d	Total Financial Assistance and Means-Tested Government Programs .	78,977,271	52,159,553	26,817,718	3.580 %
Other Benefits		3,288,214	423,444	2,864,770	0.380 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	3,288,214	423,444	2,864,770	0.380 %
f	Health professions education (from Worksheet 5) ..	7,688,795	1,397,444	6,291,351	0.840 %
g	Subsidized health services (from Worksheet 6) ..	16,437,297	10,353,538	6,083,759	0.810 %
h	Research (from Worksheet 7)	5,655,787	707,204	4,948,583	0.660 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	3,094,004		3,094,004	0.410 %
j	Total. Other Benefits ..	36,164,097	12,881,630	23,282,467	3.100 %
k	Total. Add lines 7d and 7j .	115,141,368	65,041,183	50,100,185	6.680 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	203,583	203,583	0.030 %
3	Community support
4	Environmental improvements	15,000	15,000	0 %
5	Leadership development and training for community members
6	Coalition building	500	500	0 %
7	Community health improvement advocacy
8	Workforce development	56,307	56,307	0.010 %
9	Other
10	Total	275,390	275,390	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

17,664,754

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

180,393,480

Enter Medicare allowable costs of care relating to payments on line 5.....

179,537,705

Subtract line 6 from line 5. This is the surplus (or shortfall)........

855,775

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?7 Name, address, primary website address, and state license number									Other (Describe)
1	AVERA MCKENNAN 1325 S CLIFF AVE SIOUX FALLS,SD57117 WWW.AVERAMCKENNAN.ORG 10563	X	X	X	X		X	X	34 PROVIDER BASED CLINICS
2	HEART HOSPITAL OF SOUTH DAKOTA LLC 4500 W 69TH STREET SIOUX FALLS,SD57108 WWW.AVERA.ORG/HEART-HOSPITAL 41953	X	X					X	2/3 OWNER IN JOINT VENTURE
3	AVERA GREGORY HEALTHCARE CENTER 400 PARK AVE GREGORY,SD57533 WWW.AVERA.ORG/GREGORY-HOSPITAL 54875	X	X			X		X	FOUR PROVIDER BASED CLINICS
4	AVERA MILBANK AREA HOSPITAL 901 VIRGIL AVE MILBANK,SD57252 WWW.AVERA.ORG/MILBANK 48451	X	X			X		X	THREE RURAL PROVIDER BASED CLINICS
5	AVERA DELLS AREA HEALTH CENTER 909 N IOWA AVENUE DELL RAPIDS,SD57022 WWW.AVERA.ORG/DELL-RAPIDS 50754	X	X			X		X	THREE PROVIDER BASED CLINICS
6	AVERA FLANDREAU MEDICAL CENTER 214 N PRAIRIE FLANDREAU,SD57028 WWW.AVERA.ORG/FLANDREAU-MEDICAL 10540	X	X			X		X	ONE PROVIDER BASED CLINIC
7	AVERA HAND COUNTY MEMORIAL HOSPITAL 300 W 5TH ST MILLER,SD57362 WWW.AVERA.ORG/MILLER 53862	X	X			X		X	ONE PROVIDER BASED CLINIC

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AVERA MCKENNAN
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/MCKENNAN/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	HEART HOSPITAL OF SOUTH DAKOTA LLC
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/HEART-HOSPITAL/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AVERA GREGORY HEALTHCARE CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/GREGORY-HOSPITAL/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AVERA MILBANK AREA HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/MILBANK/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AVERA DELLS AREA HEALTH CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/DELL-RAPIDS/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AVERA FLANDREAU MEDICAL CENTER
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/FLANDREAU-MEDICAL/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	AVERA HAND COUNTY MEMORIAL HOSPITAL
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.AVERA.ORG/MILLER/

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 150.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If "Yes," indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?..........	17		No
	If "Yes," check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
AVERA MCKENNAN	PART V, SECTION B, LINE 3: AVERA MCKENNAN COLLECTED DATA FROM A COMMUNITY SURVEY SPONSORED BY THE CITY OF SIOUX FALLS AND COMPLETED IN AUGUST 2012. THE FACILITY SPONSORED A SURVEY DISTRIBUTED AT TWO PUBLIC EVENTS IN 2011. AS BACKGROUND INFORMATION, A COMMUNITY NEEDS ASSESSMENT SURVEY CONDUCTED IN 2010 SUPPLEMENTED THE 2011 AND 2012 ACTIVITIES. THIS ASSESSMENT INCLUDED SURVEYS, PHONE INTERVIEWS AND FOCUS GROUPS. PERSONAL INTERVIEWS WERE CONDUCTED WITH THE EXECUTIVE DIRECTOR OF SOUTH DAKOTA URBAN INDIAN HEALTH, INC.; THE ASSISTANT DIRECTOR OF THE SIOUX FALLS DEPARTMENT OF HEALTH; SIOUX FALLS COMMUNITY HEALTH DENTAL DIRECTOR; AND MANAGER OF THE AVERA MEDICAL GROUP HEALTH CARE CLINIC.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 3: THE HEALTH NEEDS ASSESSMENT INCLUDED DATA FROM A COMMUNITY SURVEY SPONSORED BY THE CITY OF SIOUX FALLS AND COMPLETED IN AUGUST 2012. AVERA MCKENNAN SPONSORED A SURVEY DISTRIBUTED AT TWO PUBLIC EVENTS IN 2011. AS BACKGROUND INFORMATION, A COMMUNITY NEEDS ASSESSMENT SURVEY CONDUCTED IN 2010 SUPPLEMENTED THE 2011 AND 2012 ACTIVITIES. THIS ASSESSMENT INCLUDED SURVEYS, PHONE INTERVIEWS AND FOCUS GROUPS. PERSONAL INTERVIEWS WERE CONDUCTED WITH THE EXECUTIVE DIRECTOR OF SOUTH DAKOTA URBAN INDIAN HEALTH, INC.; THE ASSISTANT DIRECTOR OF THE SIOUX FALLS DEPARTMENT OF HEALTH; SIOUX FALLS COMMUNITY HEALTH DENTAL DIRECTOR; AND MANAGER OF THE AVERA MEDICAL GROUP HEALTH CARE CLINIC.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 3: AVERA GREGORY HOSPITAL BEGAN THE COMMUNITY HEALTH NEEDS ASSESSMENT WITH PRIMARY DATA COLLECTION CONSISTING OF ONE-ON-ONE INTERVIEWS AND FOCUS GROUPS WITH REPRESENTATIVES FROM WITHIN THE SERVICE AREA. THESE INDIVIDUALS SHOWED REPRESENTATION FROM CIVIC AND BUSINESS ORGANIZATIONS SUCH AS THE GREGORY PUBLIC SCHOOL SYSTEMS, THE GREGORY CHAMBER OF COMMERCE, THE DEPARTMENT OF SOCIAL SERVICES, THE GREGORY MINISTERIAL ASSOCIATION, THE GREGORY ROTARY AND GREGORY/WINNER BUSINESS OWNERS. ONE FOCUS GROUP INCLUDED THE AVERA GREGORY HOSPITAL ADVISORY BOARD, MADE UP OF COMMUNITY LEADERS WHO HAD BEEN APPOINTED BASED ON THEIR KNOWLEDGE AND INVOLVEMENT IN THE COMMUNITY AND WITH THE FOLLOWING BACKGROUNDS: MORTUARY SERVICES, BANKING, LAW AND LOCAL BUSINESS OWNERS. THE SECOND FOCUS GROUP WAS CONDUCTED AS A TOWN HALL STYLE MEETING IN WHICH 42 COMMUNITY MEMBERS ATTENDED. THE THIRD FOCUS GROUP WAS CONDUCTED WITH THE LOCAL SCHOOL BOARD, THE PRINCIPAL OF THE HIGH SCHOOL AND ELEMENTARY SCHOOL AND THE SUPERINTENDENT OF SCHOOLS FOR GREGORY COUNTY.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 3: MILBANK AREA HOSPITAL AVERA HELD FIVE FOCUS GROUPS TO SEEK THE INPUT OF COMMUNITY AND HEALTH LEADERS. THE FOCUS GROUPS WERE CONDUCTED INVOLVING THE GENERAL PUBLIC, ALL ASPECTS OF HEALTH CARE, A SERVICE ORGANIZATION, KEY COMMUNITY LEADERS, CITY AND COUNTY GOVERNMENT INCLUDING LAW ENFORCEMENT, SCHOOL NURSING AND ADMINISTRATION, AND CHURCH OFFICIALS IN ADDITION TO INDIVIDUALS WITH SPECIAL KNOWLEDGE IN PUBLIC HEALTH INCLUDING PROGRAMS FOR THE ELDERLY AND THE LOCAL RECREATIONAL FACILITY. PERSONAL INTERVIEWS WERE HELD WITH THE COUNTY'S PUBLIC HEALTH NURSES AND THE GRANT COUNTY SOCIAL WORKER.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 3: THE ASSESSMENT BEGAN BY GATHERING PRIMARY DATA ABOUT THE AVERA DELLS AREA HOSPITAL'S SERVICE AREA. KEY INFORMANT INTERVIEWS WERE COMPLETED, WHICH INCLUDED ASKING A NUMBER OF KEY QUESTIONS REGARDING THE HEALTH NEEDS OF THE COMMUNITY. THE INTERVIEWS LASTED APPROXIMATELY ONE HOUR EACH. PARTICIPANTS REPRESENTED IN THE INTERVIEW PROCESS INCLUDED: THE AVERA MEDICAL GROUP DELL RAPIDS PHYSICIANS, AVERA MEDICAL GROUP DELL RAPIDS CLINIC MANAGER, AVERA DELLS AREA HOSPITAL ADMINISTRATOR, AVERA DELLS AREA HOSPITAL DIRECTOR OF PATIENT CARE, DELL RAPIDS MAYOR, DELL RAPIDS CITY ADMINISTRATOR, MINNEHAHA COUNTY PUBLIC HEALTH ASSISTANT DIRECTOR, AREA SCHOOL NURSES, AND AVERA DELLS AREA HOSPITAL ADVISORY BOARD MEMBERS. MORE SPECIFICALLY, THE AVERA DELLS AREA HOSPITAL ADVISORY BOARD MEMBERS CONSISTED OF REPRESENTATION FROM THE FOLLOWING FIELDS/PROFESSIONS: 1) DENTAL HYGIENE, 2) SCHOOL ADMINISTRATION, 3) BANKING, 4) COLLEGE OF NURSING PROFESSOR, 5) LICENSED PRACTICAL NURSE, 6) SMALL BUSINESS, AND 7) MEDICINE.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 3: AVERA FLANDREAU MEDICAL CENTER BEGAN ITS ASSESSMENT WITH PRIMARY DATA COLLECTION CONSISTING OF ONE-ON-ONE INTERVIEWS AND WRITTEN QUESTIONNAIRES WITH REPRESENTATIVES FROM WITHIN THE SERVICE AREA. THESE INDIVIDUALS REPRESENTED CIVIC AND BUSINESS ORGANIZATIONS SUCH AS FLANDREAU AND COLMAN-EGAN PUBLIC SCHOOL SYSTEMS, FLANDREAU INDIAN BOARDING SCHOOL (A FEDERAL SCHOOL FOR NATIVE AMERICAN CHILDREN GRADES 9 - 12), FOOD PANTRY (THE BREADBASKET), PUBLIC HEALTH OFFICE, DOMESTIC VIOLENCE SHELTER, AND MOODY COUNTY PASTORAL ASSOCIATION. FOCUS GROUPS WERE ALSO UTILIZED FOR PRIMARY DATA COLLECTION USING THE ABOVE QUESTIONS. ONE FOCUS GROUP INCLUDED AFH ADVISORY BOARD, MADE UP OF COMMUNITY LEADERS WHO HAD BEEN APPOINTED BASED ON THEIR INVOLVEMENT IN THE COMMUNITY AND WITH THE ORGANIZATION. THE ADVISORY BOARD CONSISTS OF INDIVIDUALS WITH THE FOLLOWING PROFESSIONAL BACKGROUNDS: AGRICULTURE, INSURANCE, REAL ESTATE, EDUCATION, MEDICINE, AND BUSINESS OWNERSHIP. A SECOND FOCUS GROUP WAS THE MEDICAL STAFF COMMITTEE, CONSISTING OF AFH SENIOR LEADERS AND PRIMARY CARE PROVIDERS. A THIRD FOCUS GROUP WAS AFH NURSING STAFF.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 3: AVERA HAND COUNTY MEMORIAL HOSPITAL USED A SURVEY TOOL TO BEGIN THE PROCESS OF QUALITATIVE DATA COLLECTION. THE SURVEY WAS AVAILABLE TO A PATIENTS AND VISITORS FROM MARCH TO APRIL 2012. THE SURVEYS WERE COMPILED AND PRINTED FOR PRESENTATION TO VARIOUS GROUPS. AT EACH GROUP SETTING, REPRESENTATIVES OF THE FACILITY REVIEWED THE SATISFACTION RATINGS OF THE SURVEY TO BEGIN THE DIALOGUE, ASKING VARIOUS QUESTIONS TO IDENTIFY THEMES OR TRENDS. THE SMALL GROUPS MEETINGS CONSISTED OF THE HOSPITAL'S ADVISORY BOARD, DEPARTMENT MANAGERS, AUXILIARY, FOUNDATION, THE MILLER SCHOOL GUIDANCE COUNSELOR, ON HAND DEVELOPMENT LEADERSHIP, AND THE HAND COUNTY PUBLIC HEALTH NURSE.
AVERA MCKENNAN	PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED WITH HEART HOSPITAL OF SOUTH DAKOTA, LLC.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED WITH AVERA MCKENNAN.
AVERA MCKENNAN	PART V, SECTION B, LINE 6I: AVERA MCKENNAN ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS FOUR OF THE MOST COMMONLY AND HIGHLY IDENTIFIED NEEDS. THOSE FOUR NEEDS ARE OBSEITY/POOR DIET/LACK OF EXERCISE, HEALTH CARE ACCESS FOR UNINSURED/UNDERINSURED PEOPLE INCLUDING SPECIALTY CARE AND MENTAL HEALTH SERVICES, MANAGEMENT OF CHRONIC CONDITIONS AND SMOKING/ALCOHOL USE. THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/MCKENNAN/ABOUT/AVERA-MCKENNAN-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.HEART HOSPITAL IS OPERATED AS A JOINT VENTURE IN WHICH AVERA MCKENNAN HAS 66.67% OWNERSHIP. AVERA MCKENNAN PROVIDES MANAGEMENT SERVICES AND ENSURES THE HOSPITAL OPERATES WITH A CHARITABLE INTENT. BASED ON PROPOSED REGULATION 1.501(R)-1(C)(2), AVERA MCKENNAN IS TREATING THE HEART HOSPITAL AS A FACILITY SUBJECT TO THE RULES UNDER 501(R).
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA MCKENNAN	PART V, SECTION B, LINE 7: DENTAL CARE WAS A NEED IDENTIFIED BUT NOT DIRECTLY ADDRESSED AS IT WAS NOT ONE OF THE HIGHEST PRIORITIES. IN ADDITION, IT IS OUTSIDE THE FACILITY'S COMPETENCIES AND IS ALREADY ADDRESSED BY CITY OF SIOUX FALLS HEALTH DEPARTMENT, FALLS COMMUNITY HEALTH. AVERA MEDICAL GROUP HEALTH CARE CLINIC DOES FACILITATE DISTRIBUTION OF VOUCHERS FOR DENTAL CARE WHICH ARE PROVIDED THROUGH DONATIONS.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 7: HEART HOSPITAL WILL ADDRESS COMMUNITY CONCERNS OF HEALTH CARE ACCESS FOR UNINSURED/UNDERINSURED, OBESITY/POOR DIET, MANAGEMENT OF CHRONIC CONDITIONS, AND SMOKING USE THROUGH CURRENT SERVICE OFFERINGS IN ADDITION TO PARTNERING WITH THE CITY AND OTHER COMMUNITY HEALTH CARE ENTITIES. OTHER NEEDS IDENTIFIED SUCH AS DENTAL CARE, BEHAVIORAL HEALTH SERVICES AND ACCESS TO EXERCISE FACILITIES WERE A LOWER PRIORITY AND ARE NOT WITHIN THE HOSPITAL'S CORE COMPETENCIES.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 7: THREE NEEDS WERE IDENTIFIED AND NOT ADDRESSED. REDUCING TOBACCO USE WAS IDENTIFIED BUT NOT INCLUDED IN THE IMPLEMENTATION PLAN DUE TO LACK OF FINANCIAL RESOURCES, COMPETING PRIORITIES AND PROJECTS, AND A DOWNWARD USE TREND UNDER CURRENT INTERVENTIONS. PROVIDING DERMATOLOGY AND OPHTHALMOLOGY SERVICES WERE NOT ADDRESSED DUE TO DIFFICULTY IN RECRUITING SPECIALISTS DUE TO POPULATION DENSITY, LACK OF FINANCIAL RESOURCES, AND COMPLEXITY OF THE SERVICES.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 7: ONE NEED WAS IDENTIFIED AND NOT ADDRESSED: LACK OF KIDNEY DIALYSIS AVAILABLE IN THE COMMUNITY. THERE IS A PROVIDER AT A FACILITY 12 MILES TO THE EAST OF MILBANK AREA HOSPITAL (MAH) AVERA. MAH AVERA DOES NOT CURRENTLY HAVE THE EQUIPMENT AND DEDICATED SPACE NEEDED TO PROVIDE THE SERVICE. THE FACILITY CONTINUES RESEARCHING THE SERVICE AND WILL DECIDE AT A LATER DATE IF IT WILL BE ABLE TO ADDRESS THE NEED.
AVERA MCKENNAN	PART V, SECTION B, LINE 14G: AVERA MCKENNAN'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 14G: HEART HOSPITAL OF SOUTH DAKOTA'S POLICY IS MADE AVAILABLE UPON REQUEST AND IS PROVIDED AND DISCUSSED WITH PATIENT AS THE NEED IS IDENTIFIED. IT IS ALSO AVAILABLE VIA THE WEBSITE.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 14G: AVERA GREGORY HEALTHCARE CENTER'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 14G: AVERA MILBANK AREA HOSPITAL'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 14G: AVERA DELLS AREA HEALTH CENTER'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 14G: AVERA FLANDREAU MEDICAL CENTER'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 14G: AVERA HAND COUNTY MEMORIAL HOSPITAL'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA MCKENNAN	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?59
Name and address		Type of Facility (describe)
1	AVERA MCKENNAN BEHAVIORAL HEALTH CENTER 4400 W 69TH ST SIOUX FALLS,SD57108	INPATIENT & OUTPATIENT BEHAVIORAL HEALTH SERVICES
2	CORE ORTHOPEDICS AVERA MEDICAL GROUP 2908 EAST 26TH STREET SIOUX FALLS,SD57103	ORTHOPEDIC CLINIC
3	AVERA PLAZA 2 PHARMACY 1301 S CLIFF AVENUE SIOUX FALLS,SD57105	RETAIL PHARMACY
4	AVERA PRINCE OF PEACE 4500 S PRINCE OF PEACE PLACE SIOUX FALLS,SD57103	SKILLED NURSING FACILITY
5	AVERA MEDICAL GROUP SPENCER 116 EAST 11TH SUITE 101 SPENCER,IA51301	PRIMARY CARE CLINIC
6	AVERA MCKENNAN HOME INFUSION 1020 S CLIFF AVENUE SIOUX FALLS,SD57105	COMPREHENSIVE HOME INFUSION THERAPIES & SUPPLIES
7	AVERA MEDICAL GROUP WORTHINGTON 508 TENTH STREET WORTHINGTON,MN56187	PRIMARY CARE CLINIC
8	PET CT 6001 SHARON AVENUE SIOUX FALLS,SD57108	RADIOLOGY SERVICES
9	MCKENNAN REGIONAL LABORATORY 1325 S CLIFF AVENUE SIOUX FALLS,SD57105	LABORATORY SERVICES
10	AVERA HOME MEDICAL EQUIPMENT 2400 S MINNESOTA AVE SIOUX FALLS,SD57105	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
11	AVERA MEDICAL GROUP MATERNAL FETAL MED 1417 SOUTH CLIFF AVENUE SUITE 100 SIOUX FALLS,SD57105	HIGH-RISK PREGNANCY CARE CLINIC
12	AVERA MEDICAL GROUP PEDIATRIC SPECIALIST 1417 S CLIFF AVENUE SUITE 010 SIOUX FALLS,SD57105	PEDIATRIC SPECIALTIES CLINIC
13	AVERA MCKENNAN FITNESS CENTER 3400 S SOUTHEASTERN DRIVE SIOUX FALLS,SD57105	FITNESS CENTER
14	AVERA MCKENNAN HOSP & UNIV CAMPUS PHARM 1325 S CLIFF AVENUE SIOUX FALLS,SD57105	RETAIL PHARMACY
15	AVERA ROSEBUD COUNTRY CARE CENTER 300 PARK AVENUE GREGORY,SD57533	SKILLED NURSING FACILITY
16	AVERA MEDICAL GROUP WINDOM 820 - 2ND AVENUE WINDOM,MN56101	PRIMARY CARE CLINIC
17	AVERA HOME MEDICAL EQUIPMENT 1104 EAST COLLEGE DR MARSHALL,SD56258	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
18	AVERA MEDICAL GROUP SIBLEY 600-9TH AVENUE NORTH SIBLEY,IA51249	PRIMARY CARE CLINIC
19	AVERA HOME MEDICAL EQUIPMENT 418 S 2ND STREET ABERDEEN,SD57401	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
20	AVERA 69TH STREET PHARMACY - BEHAVIORAL 4400 W 69TH ST SUITE 300 SIOUX FALLS,SD57108	RETAIL PHARMACY
21	AVERA HOME MEDICAL EQUIPMENT 1001 W 9TH STREET YANKTON,SD57078	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
22	LAUREL OAKS APARTMENTS 4510 S PRINCE OF PEACE PLACE SIOUX FALLS,SD57103	INDEPENDENT LIVING APARTMENTS
23	AVERA MEDICAL GROUP COMPREHENSIVE BREAST 1000 EAST 23RD STREET SUITE 360 SIOUX FALLS,SD57105	SPECIALTY CLINIC
24	AVERA HOME MEDICAL EQUIPMENT 1307 N MAIN MITCHELL,SD57301	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
25	AVERA HOME MEDICAL EQUIPMENT 1411 WELLS AVE PIERRE,SD57501	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
26	AVERA HOME MEDICAL EQUIPMENT 100 22ND AVENUE STE 101 BROOKINGS,SD57006	PRIMARY CARE CLINIC
27	AVERA MEDICAL GROUP OCCUPATIONAL MED 4928 NORTH CLIFF AVENUE SIOUX FALLS,SD57104	BUSINESS AND CORPORATE HEALTH CARE CLINIC
28	AVERA HOME MEDICAL EQUIPMENT 1508 4TH STREET NE WATERTOWN,SD57201	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
29	AVERA DERMATOLOGY PHARMACY 6701 SOUTH MINNESOTA AVENUE SIOUX FALLS,SD57108	RETAIL PHARMACY
30	AVERA MEDICAL GROUP MCGREEVY SALEM 740 SOUTH HILL SALEM,SD57058	PRIMARY CARE CLINIC
31	AVERA RESEARCH INSTITUTE 2020 S NORTON AVE SIOUX FALLS,SD57105	CLINICAL RESEARCH STUDIES
32	AVERA HOME MEDICAL EQUIP FLOYD VALLEY 190 6TH AVE NE LEMARS,IA51031	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
33	AVERA MEDICAL GROUP WOMEN'S MIDLIFE CARE 911 EAST 20TH STREET - SUITE 200 SIOUX FALLS,SD57105	WOMEN'S SERVICES CLINIC
34	AVERA INSTITUTE FOR HUMAN GENETICS 4400 W 69TH ST SUITE 200 SIOUX FALLS,SD57108	GENETIC RESEARCH PROGRAM
35	AVERA HOME MEDICAL EQUIPMENT 38 19TH STREET SW SIOUX CENTER,IA51250	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
36	AVERA HOME MEDICAL EQUIPMENT 602 CENTRAL AVE ESTHERVILLE,IA51334	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
37	AVERA HOME MEDICAL EQUIPMENT 903 N WASHINGTON MADISON,SD57042	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
38	AVERA HOME MEDICAL EQUIPMENT 1325 SOUTH CLIFF AVENUE SIOUX FALLS,SD57117	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
39	AVERA HOME MEDICAL EQUIPMENT OF SPENCER 716 GRAND AVE SPENCER,IA51301	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
40	AVERA HOME MEDICAL EQUIPMENT 102 WEST MAIN SUITE A PARKSTON,SD57366	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
41	AVERA HOME MEDICAL EQUIPMENT 1565 DAKOTA AVE S HURON,SD57350	RENTAL & SALE OF HOME MEDICAL EQUIPMENT
42	AVERA MEDICAL GROUP LARCHWOOD 916 HOLDER STREET PO BOX 8 LARCHWOOD,IA51241	PRIMARY CARE CLINIC
43	AVERA LEE MABEE OBGYN 1910 WEST 69TH SUITE 100 SIOUX FALLS,SD57108	OBSTETRIC AND GYNECOLOGY CLINIC
44	CURAQUICK AVERA CLINIC 3000 S MINNESOTA AVE SIOUX FALLS,SD57105	PRIMARY CARE CLINIC
45	AVERA MEDICAL GROUP BIG STONE CITY 451 MAIN STREET BIG STONE CITY,SD57216	PRIMARY CARE CLINIC
46	COMMUNITY BLOOD BANK 1301 SOUTH CLIFF AVENUE SUITE 3 SIOUX FALLS,SD57105	COMMUNITY BLOOD SERVICES
47	HEGG MEDICAL CLINIC AVERA 2121 HEGG DRIVE ROCK VALLEY,IA51247	PRIMARY CARE CLINIC
48	AVERA MEDICAL GROUP ESTHERVILLE 926 NORTH 8TH STREET ESTHERVILLE,IA51334	PRIMARY CARE CLINIC
49	HEALTH CARE CLINIC 300 NORTH DAKOTA AVENUE SUITE 117 SIOUX FALLS,SD57104	FREE HEALTHCARE CLINIC
50	PIPESTONE MEDICAL GROUP AVERA 920 - 4TH AVENUE SW PIPESTONE,MN56164	PRIMARY CARE CLINIC
51	AVERA MEDICAL GROUP CHAMBERLAIN 101 SOUTH FRONT PO BOX 27 CHAMBERLAIN,SD57325	PRIMARY CARE CLINIC
52	RURAL MEDICAL CLINICS 301 SOUTH WALNUT STREET FREEMAN,SD57029	PRIMARY CARE CLINIC
53	AVERA MEDICAL GROUP OPTOMETRY 702 TENTH STREET WORTHINGTON,MN56187	OPHTHALMOLOGY AND OPTOMETRY CLINIC
54	YORKSHIRE EYE CLINIC 2311 YORKSHIRE DRIVE BROOKINGS,SD57006	OPHTHALMOLOGY AND OPTOMETRY CLINIC
55	AVERA MEDICAL GROUP BUTTE 730 WILSON STREET BUTTE,NE68722	SATELLITE PRIMARY CARE CLINIC
56	AVERA MEDICAL GROUP ELKTON 203 ELK STREET ELKTON,SD57026	SATELLITE PRIMARY CARE CLINIC
57	AVERA MEDICAL GROUP FULDA 201 N ST PAUL AVENUE FULDA,MN56131	SATELLITE PRIMARY CARE CLINIC
58	AVERA MEDICAL GROUP LAKEFIELD 221 - 3RD AVENUE LAKEFIELD,MN56150	SATELLITE PRIMARY CARE CLINIC
59	AVERA MEDICAL GROUP VOLGA 210 KASAN AVENUE VOLGA,SD57071	SATELLITE PRIMARY CARE CLINIC

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
AVERA MCKENNAN	PART V, SECTION B, LINE 3: AVERA MCKENNAN COLLECTED DATA FROM A COMMUNITY SURVEY SPONSORED BY THE CITY OF SIOUX FALLS AND COMPLETED IN AUGUST 2012. THE FACILITY SPONSORED A SURVEY DISTRIBUTED AT TWO PUBLIC EVENTS IN 2011. AS BACKGROUND INFORMATION, A COMMUNITY NEEDS ASSESSMENT SURVEY CONDUCTED IN 2010 SUPPLEMENTED THE 2011 AND 2012 ACTIVITIES. THIS ASSESSMENT INCLUDED SURVEYS, PHONE INTERVIEWS AND FOCUS GROUPS. PERSONAL INTERVIEWS WERE CONDUCTED WITH THE EXECUTIVE DIRECTOR OF SOUTH DAKOTA URBAN INDIAN HEALTH, INC.; THE ASSISTANT DIRECTOR OF THE SIOUX FALLS DEPARTMENT OF HEALTH; SIOUX FALLS COMMUNITY HEALTH DENTAL DIRECTOR; AND MANAGER OF THE AVERA MEDICAL GROUP HEALTH CARE CLINIC.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 3: THE HEALTH NEEDS ASSESSMENT INCLUDED DATA FROM A COMMUNITY SURVEY SPONSORED BY THE CITY OF SIOUX FALLS AND COMPLETED IN AUGUST 2012. AVERA MCKENNAN SPONSORED A SURVEY DISTRIBUTED AT TWO PUBLIC EVENTS IN 2011. AS BACKGROUND INFORMATION, A COMMUNITY NEEDS ASSESSMENT SURVEY CONDUCTED IN 2010 SUPPLEMENTED THE 2011 AND 2012 ACTIVITIES. THIS ASSESSMENT INCLUDED SURVEYS, PHONE INTERVIEWS AND FOCUS GROUPS. PERSONAL INTERVIEWS WERE CONDUCTED WITH THE EXECUTIVE DIRECTOR OF SOUTH DAKOTA URBAN INDIAN HEALTH, INC.; THE ASSISTANT DIRECTOR OF THE SIOUX FALLS DEPARTMENT OF HEALTH; SIOUX FALLS COMMUNITY HEALTH DENTAL DIRECTOR; AND MANAGER OF THE AVERA MEDICAL GROUP HEALTH CARE CLINIC.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 3: AVERA GREGORY HOSPITAL BEGAN THE COMMUNITY HEALTH NEEDS ASSESSMENT WITH PRIMARY DATA COLLECTION CONSISTING OF ONE-ON-ONE INTERVIEWS AND FOCUS GROUPS WITH REPRESENTATIVES FROM WITHIN THE SERVICE AREA. THESE INDIVIDUALS SHOWED REPRESENTATION FROM CIVIC AND BUSINESS ORGANIZATIONS SUCH AS THE GREGORY PUBLIC SCHOOL SYSTEMS, THE GREGORY CHAMBER OF COMMERCE, THE DEPARTMENT OF SOCIAL SERVICES, THE GREGORY MINISTERIAL ASSOCIATION, THE GREGORY ROTARY AND GREGORY/WINNER BUSINESS OWNERS. ONE FOCUS GROUP INCLUDED THE AVERA GREGORY HOSPITAL ADVISORY BOARD, MADE UP OF COMMUNITY LEADERS WHO HAD BEEN APPOINTED BASED ON THEIR KNOWLEDGE AND INVOLVEMENT IN THE COMMUNITY AND WITH THE FOLLOWING BACKGROUNDS: MORTUARY SERVICES, BANKING, LAW AND LOCAL BUSINESS OWNERS. THE SECOND FOCUS GROUP WAS CONDUCTED AS A TOWN HALL STYLE MEETING IN WHICH 42 COMMUNITY MEMBERS ATTENDED. THE THIRD FOCUS GROUP WAS CONDUCTED WITH THE LOCAL SCHOOL BOARD, THE PRINCIPAL OF THE HIGH SCHOOL AND ELEMENTARY SCHOOL AND THE SUPERINTENDENT OF SCHOOLS FOR GREGORY COUNTY.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 3: MILBANK AREA HOSPITAL AVERA HELD FIVE FOCUS GROUPS TO SEEK THE INPUT OF COMMUNITY AND HEALTH LEADERS. THE FOCUS GROUPS WERE CONDUCTED INVOLVING THE GENERAL PUBLIC, ALL ASPECTS OF HEALTH CARE, A SERVICE ORGANIZATION, KEY COMMUNITY LEADERS, CITY AND COUNTY GOVERNMENT INCLUDING LAW ENFORCEMENT, SCHOOL NURSING AND ADMINISTRATION, AND CHURCH OFFICIALS IN ADDITION TO INDIVIDUALS WITH SPECIAL KNOWLEDGE IN PUBLIC HEALTH INCLUDING PROGRAMS FOR THE ELDERLY AND THE LOCAL RECREATIONAL FACILITY. PERSONAL INTERVIEWS WERE HELD WITH THE COUNTY'S PUBLIC HEALTH NURSES AND THE GRANT COUNTY SOCIAL WORKER.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 3: THE ASSESSMENT BEGAN BY GATHERING PRIMARY DATA ABOUT THE AVERA DELLS AREA HOSPITAL'S SERVICE AREA. KEY INFORMANT INTERVIEWS WERE COMPLETED, WHICH INCLUDED ASKING A NUMBER OF KEY QUESTIONS REGARDING THE HEALTH NEEDS OF THE COMMUNITY. THE INTERVIEWS LASTED APPROXIMATELY ONE HOUR EACH. PARTICIPANTS REPRESENTED IN THE INTERVIEW PROCESS INCLUDED: THE AVERA MEDICAL GROUP DELL RAPIDS PHYSICIANS, AVERA MEDICAL GROUP DELL RAPIDS CLINIC MANAGER, AVERA DELLS AREA HOSPITAL ADMINISTRATOR, AVERA DELLS AREA HOSPITAL DIRECTOR OF PATIENT CARE, DELL RAPIDS MAYOR, DELL RAPIDS CITY ADMINISTRATOR, MINNEHAHA COUNTY PUBLIC HEALTH ASSISTANT DIRECTOR, AREA SCHOOL NURSES, AND AVERA DELLS AREA HOSPITAL ADVISORY BOARD MEMBERS. MORE SPECIFICALLY, THE AVERA DELLS AREA HOSPITAL ADVISORY BOARD MEMBERS CONSISTED OF REPRESENTATION FROM THE FOLLOWING FIELDS/PROFESSIONS: 1) DENTAL HYGIENE, 2) SCHOOL ADMINISTRATION, 3) BANKING, 4) COLLEGE OF NURSING PROFESSOR, 5) LICENSED PRACTICAL NURSE, 6) SMALL BUSINESS, AND 7) MEDICINE.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 3: AVERA FLANDREAU MEDICAL CENTER BEGAN ITS ASSESSMENT WITH PRIMARY DATA COLLECTION CONSISTING OF ONE-ON-ONE INTERVIEWS AND WRITTEN QUESTIONNAIRES WITH REPRESENTATIVES FROM WITHIN THE SERVICE AREA. THESE INDIVIDUALS REPRESENTED CIVIC AND BUSINESS ORGANIZATIONS SUCH AS FLANDREAU AND COLMAN-EGAN PUBLIC SCHOOL SYSTEMS, FLANDREAU INDIAN BOARDING SCHOOL (A FEDERAL SCHOOL FOR NATIVE AMERICAN CHILDREN GRADES 9 - 12), FOOD PANTRY (THE BREADBASKET), PUBLIC HEALTH OFFICE, DOMESTIC VIOLENCE SHELTER, AND MOODY COUNTY PASTORAL ASSOCIATION. FOCUS GROUPS WERE ALSO UTILIZED FOR PRIMARY DATA COLLECTION USING THE ABOVE QUESTIONS. ONE FOCUS GROUP INCLUDED AFH ADVISORY BOARD, MADE UP OF COMMUNITY LEADERS WHO HAD BEEN APPOINTED BASED ON THEIR INVOLVEMENT IN THE COMMUNITY AND WITH THE ORGANIZATION. THE ADVISORY BOARD CONSISTS OF INDIVIDUALS WITH THE FOLLOWING PROFESSIONAL BACKGROUNDS: AGRICULTURE, INSURANCE, REAL ESTATE, EDUCATION, MEDICINE, AND BUSINESS OWNERSHIP. A SECOND FOCUS GROUP WAS THE MEDICAL STAFF COMMITTEE, CONSISTING OF AFH SENIOR LEADERS AND PRIMARY CARE PROVIDERS. A THIRD FOCUS GROUP WAS AFH NURSING STAFF.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 3: AVERA HAND COUNTY MEMORIAL HOSPITAL USED A SURVEY TOOL TO BEGIN THE PROCESS OF QUALITATIVE DATA COLLECTION. THE SURVEY WAS AVAILABLE TO A PATIENTS AND VISITORS FROM MARCH TO APRIL 2012. THE SURVEYS WERE COMPILED AND PRINTED FOR PRESENTATION TO VARIOUS GROUPS. AT EACH GROUP SETTING, REPRESENTATIVES OF THE FACILITY REVIEWED THE SATISFACTION RATINGS OF THE SURVEY TO BEGIN THE DIALOGUE, ASKING VARIOUS QUESTIONS TO IDENTIFY THEMES OR TRENDS. THE SMALL GROUPS MEETINGS CONSISTED OF THE HOSPITAL'S ADVISORY BOARD, DEPARTMENT MANAGERS, AUXILIARY, FOUNDATION, THE MILLER SCHOOL GUIDANCE COUNSELOR, ON HAND DEVELOPMENT LEADERSHIP, AND THE HAND COUNTY PUBLIC HEALTH NURSE.
AVERA MCKENNAN	PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED WITH HEART HOSPITAL OF SOUTH DAKOTA, LLC.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 4: THE CHNA WAS CONDUCTED WITH AVERA MCKENNAN.
AVERA MCKENNAN	PART V, SECTION B, LINE 6I: AVERA MCKENNAN ADOPTED AN IMPLEMENTATION STRATEGY TO ADDRESS FOUR OF THE MOST COMMONLY AND HIGHLY IDENTIFIED NEEDS. THOSE FOUR NEEDS ARE OBSEITY/POOR DIET/LACK OF EXERCISE, HEALTH CARE ACCESS FOR UNINSURED/UNDERINSURED PEOPLE INCLUDING SPECIALTY CARE AND MENTAL HEALTH SERVICES, MANAGEMENT OF CHRONIC CONDITIONS AND SMOKING/ALCOHOL USE. THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/MCKENNAN/ABOUT/AVERA-MCKENNAN-COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.HEART HOSPITAL IS OPERATED AS A JOINT VENTURE IN WHICH AVERA MCKENNAN HAS 66.67% OWNERSHIP. AVERA MCKENNAN PROVIDES MANAGEMENT SERVICES AND ENSURES THE HOSPITAL OPERATES WITH A CHARITABLE INTENT. BASED ON PROPOSED REGULATION 1.501(R)-1(C)(2), AVERA MCKENNAN IS TREATING THE HEART HOSPITAL AS A FACILITY SUBJECT TO THE RULES UNDER 501(R).
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTP://WWW.AVERA.ORG/EXPERIENCE/SHARED/COMMUNITY-NEEDS-HEALTH-ASSESSMENTS/.
AVERA MCKENNAN	PART V, SECTION B, LINE 7: DENTAL CARE WAS A NEED IDENTIFIED BUT NOT DIRECTLY ADDRESSED AS IT WAS NOT ONE OF THE HIGHEST PRIORITIES. IN ADDITION, IT IS OUTSIDE THE FACILITY'S COMPETENCIES AND IS ALREADY ADDRESSED BY CITY OF SIOUX FALLS HEALTH DEPARTMENT, FALLS COMMUNITY HEALTH. AVERA MEDICAL GROUP HEALTH CARE CLINIC DOES FACILITATE DISTRIBUTION OF VOUCHERS FOR DENTAL CARE WHICH ARE PROVIDED THROUGH DONATIONS.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 7: HEART HOSPITAL WILL ADDRESS COMMUNITY CONCERNS OF HEALTH CARE ACCESS FOR UNINSURED/UNDERINSURED, OBESITY/POOR DIET, MANAGEMENT OF CHRONIC CONDITIONS, AND SMOKING USE THROUGH CURRENT SERVICE OFFERINGS IN ADDITION TO PARTNERING WITH THE CITY AND OTHER COMMUNITY HEALTH CARE ENTITIES. OTHER NEEDS IDENTIFIED SUCH AS DENTAL CARE, BEHAVIORAL HEALTH SERVICES AND ACCESS TO EXERCISE FACILITIES WERE A LOWER PRIORITY AND ARE NOT WITHIN THE HOSPITAL'S CORE COMPETENCIES.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 7: THREE NEEDS WERE IDENTIFIED AND NOT ADDRESSED. REDUCING TOBACCO USE WAS IDENTIFIED BUT NOT INCLUDED IN THE IMPLEMENTATION PLAN DUE TO LACK OF FINANCIAL RESOURCES, COMPETING PRIORITIES AND PROJECTS, AND A DOWNWARD USE TREND UNDER CURRENT INTERVENTIONS. PROVIDING DERMATOLOGY AND OPHTHALMOLOGY SERVICES WERE NOT ADDRESSED DUE TO DIFFICULTY IN RECRUITING SPECIALISTS DUE TO POPULATION DENSITY, LACK OF FINANCIAL RESOURCES, AND COMPLEXITY OF THE SERVICES.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 7: ONE NEED WAS IDENTIFIED AND NOT ADDRESSED: LACK OF KIDNEY DIALYSIS AVAILABLE IN THE COMMUNITY. THERE IS A PROVIDER AT A FACILITY 12 MILES TO THE EAST OF MILBANK AREA HOSPITAL (MAH) AVERA. MAH AVERA DOES NOT CURRENTLY HAVE THE EQUIPMENT AND DEDICATED SPACE NEEDED TO PROVIDE THE SERVICE. THE FACILITY CONTINUES RESEARCHING THE SERVICE AND WILL DECIDE AT A LATER DATE IF IT WILL BE ABLE TO ADDRESS THE NEED.
AVERA MCKENNAN	PART V, SECTION B, LINE 14G: AVERA MCKENNAN'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 14G: HEART HOSPITAL OF SOUTH DAKOTA'S POLICY IS MADE AVAILABLE UPON REQUEST AND IS PROVIDED AND DISCUSSED WITH PATIENT AS THE NEED IS IDENTIFIED. IT IS ALSO AVAILABLE VIA THE WEBSITE.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 14G: AVERA GREGORY HEALTHCARE CENTER'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 14G: AVERA MILBANK AREA HOSPITAL'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 14G: AVERA DELLS AREA HEALTH CENTER'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 14G: AVERA FLANDREAU MEDICAL CENTER'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 14G: AVERA HAND COUNTY MEMORIAL HOSPITAL'S SUMMARY OF THE POLICY IS POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM OR WAITING ROOMS, ADMISSIONS OFFICES, AND IS PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY.
AVERA MCKENNAN	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
HEART HOSPITAL OF SOUTH DAKOTA, LLC	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.
AVERA GREGORY HEALTHCARE CENTER	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA MILBANK AREA HOSPITAL	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA DELLS AREA HEALTH CENTER	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA FLANDREAU MEDICAL CENTER	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.
AVERA HAND COUNTY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 22: INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE NOT CHARGED GROSS CHARGES FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE; HOWEVER MAY BE CHARGED GROSS CHARGES FOR ELECTIVE CARE.

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
AVERA MCKENNAN

Employer identification number
46-0224743

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance
(1) BRANDON VALLEY BOOSTER CLUB INC PO BOX 572 BRANDON,SD57005	46-0393971	501(C)(3)	6,500				DONATION
(2) CANTON SCHOOL DISTRICT 800 N MAIN CANTON,SD57013	46-6002143	STATE OF SD	10,000				DONATION
(3) CATHOLIC DIOCESE 523 N DULUTH AVE SIOUX FALLS,SD57104	46-6000424	501(C)(3)	63,957				DONATION
(4) DAKOTABILITIES INC 3600 S DULUTH AVE SIOUX FALLS,SD57105	46-0306216	501(C)(3)	13,333				DONATION
(5) DESTINY HEALTHCARE INTERNATIONAL 2701 S MINNESOTA AVE 3 SIOUX FALLS,SD57105	51-0529480	501(C)(3)	15,000				DONATION
(6) EMBE 300 W 11TH STREET SIOUX FALLS,SD57104	46-0234998	501(C)(3)	50,000				DONATION
(7) FACE IT SIOUX FALLS PO BOX 5127 SIOUX FALLS,SD57117	94-3472044	501(C)(3)	40,000				DONATION
(8) FORWARD SIOUX FALLS PO BOX 907 SIOUX FALLS,SD57101	46-0396647	501(C)(6)	14,161				DONATION
(9) FURNITURE MISSION OF SOUTH DAKOTA INC 209 N NESMITH SIOUX FALLS,SD57103	81-0584500	501(C)(3)	6,000				DONATION
(10) HABITAT FOR HUMANITY OF GREATER SIOUX FALLS INC 721 E AMIDON ST SIOUX FALLS,SD57105	46-0407140	501(C)(3)	25,000				DONATION
(11) HARRISBURG DAYS FOUNDATION PO BOX 343 HARRISBURG,SD57032	84-1709233	501(C)(3)	16,666				DONATION
(12) HELPLINE CENTER 1000 N WEST AVE STE 310 SIOUX FALLS,SD57104	23-7424387	501(C)(3)	16,500				DONATION
(13) JUNIOR ACHIEVEMENT OF SOUTH DAKOTA 100 N WEST AVENUE NO 110 SIOUX FALLS,SD57104	46-0306352	501(C)(3)	8,250				DONATION
(14) MAP FOR NONPROFITS INC 2314 UNIVERISTY AVENUE WEST STE 28 ST PAUL,MN55114	41-1479097	501(C)(3)	15,000				DONATION
(15) MCCROSSAN BOYS RANCH 47135 260TH STREET SIOUX FALLS,SD57107	46-0311913	501(C)(3)	7,000				DONATION
(16) NAMI OF SOUTH DAKOTA PO BOX 88808 SIOUX FALLS,SD57109	36-3593027	501(C)(3)	15,000				DONATION
(17) NATIONAL KIDNEY FOUNDATION 1100 E 21ST STREET AVERA DOCTORS PLAZA 2 STE 210 SIOUX FALLS,SD57105	46-0448030	501(C)(3)	22,000				DONATION
(18) NATIONAL MULTIPLE SCLEROSIS SOCIETY UPPER MIDWEST CHAPTER 200 12TH AVE S MINNEAPOLIS,MN55415	41-0790658	501(C)(3)	13,500				DONATION
(19) NORTHEASTERN SOUTH DAKOTA HEALTH PLAN PO BOX 425 MILBANK,SD57252	46-0430984	501(C)(3)	150,000				DONATION
(20) PRESENTATION SISTERS 1500 N 2ND ST ABERDEEN,SD57401	46-0253283	501(C)(3)	7,500				DONATION
(21) RONALD MCDONALD HOUSE 2001 S NORTON SIOUX FALLS,SD57105	46-0371152	501(C)(3)	27,000	165,332	FMV	RENTED SPACE	DONATION
(22) SALES & MARKETING EXECUTIVES PO BOX 90310 SIOUX FALLS,SD57109	46-6012934	501(C)(6)	5,025				DONATION
(23) SERTOMA BUTTERFLY HOUSE INC 4320 SOUTH OXBOW AVE SIOUX FALLS,SD57106	52-2370420	501(C)(3)	7,000				DONATION
(24) SIOUX CENTER COMMUNITY HOSPITAL AND HEALTH CENTER 605 SOUTH MAIN STREET SIOUX CENTER,IA51250	42-0796764	501(C)(3)	10,500				DONATION
(25) SIOUX EMPIRE BASEBALL ASSOCIATION 1601 W 44TH PL SUITE 3 SIOUX FALLS,SD57105	41-1903475	501(C)(3)	23,611				DONATION
(26) SIOUX EMPIRE FASTPITCH SOFTBALL PO BOX 88206 SIOUX FALLS,SD57109	23-7223489	501(C)(3)	17,500				DONATION
(27) SIOUX EMPIRE UNITED WAY 1000 N WEST AVE 120 SIOUX FALLS,SD57104	46-0233701	501(C)(3)	84,500				DONATION
(28) SIOUX FALLS CATHOLIC SCHOOLS 3100 W 41ST STREET SIOUX FALLS,SD57105	51-0145184	501(C)(3)	800,150				DONATION
(29) SIOUX FALLS JAZZ & BLUES SOCIETY 123 S MAIN AVE SUITE 204 SIOUX FALLS,SD571046430	46-0418356	501(C)(3)	10,000				DONATION
(30) SIOUX FALLS SCHOOL DISTRICT 201 E 38TH ST SIOUX FALLS,SD57105	46-6002586	STATE OF SD	56,382				DONATION
(31) SOUTH DAKOTA PARKS AND WILDLIFE FOUNDATION 523 E CAPITOL AVE PIERRE,SD57501	46-0387968	501(C)(3)	10,000				DONATION
(32) SOUTH DAKOTA STATE UNIVERSITY PO BOX 2218 BROOKINGS,SD57007	46-0273801	STATE OF SD	1,017,500				DONATION
(33) SOUTH DAKOTA SYMPHONY ORCHESTRA 301 S MAIN AVE 4TH FL SIOUX FALLS,SD57104	46-6017026	501(C)(3)	35,500				DONATION
(34) TALLGRASS RECOVERY & SOBER LIVING HOMES 2601 S MINNESOTA AVE SIOUX FALLS,SD571054742	20-0293050	501(C)(3)	7,500				DONATION
(35) UNIVERISITY OF SIOUX FALLS 1101 WEST 22ND ST SIOUX FALLS,SD57105	46-0224600	501(C)(3)	220,000				DONATION
(36) UNIVERISITY OF SOUTH DAKOTA 1400 W 22ND ST SIOUX FALLS,SD57105	46-6000364	STATE OF SD	28,000				DONATION
(37) VOLUNTEERS OF AMERICA DAKOTAS 1401 W 51ST SIOUX FALLS,SD57105	23-7353508	501(C)(3)	5,886				DONATION
(38) WASHINGTON PAVILION PO BOX 984 SIOUX FALLS,SD57101	46-0435791	501(C)(3)	45,000				DONATION
(39) AMERICAN CANCER SOCIETY 4904 S TECHNOPOLIS DRIVE SIOUX FALLS,SD57106	13-1788491	501(C)(3)	33,450				DONATION
(40) AMERICAN PSYCHIATRIC ASSOCIATION 1000 WILSON BLVD NO 1825 ARLINGTON,VA22209	52-2168499	501(C)(6)	7,000				DONATION
(41) AMYOTROPHIC LATERAL SCLEROSIS ASSOCIATION MINNESOTA CHAPTER 333 WASHINGTON AVE N STE 105 MINNEAPOLIS,MN55401	41-1756085	501(C)(3)	20,000				DONATION
(42) ANGEL FLIGHT CENTRAL INC 10 RICHARDS ROAD KANSAS CITY,MO64116	43-1699607	501(C)(3)	15,800				DONATION
(43) ARTHRITIS FOUNDATION INC 1876 N MINNEHAHA AVE W ST PAUL,MN55104	39-0860526	501(C)(3)	10,000				DONATION
(44) BOYS AND GIRLS CLUB OF THE SIOUX EMPIRE 824 E 14TH STREET SIOUX FALLS,SD57104	46-0399482	501(C)(3)	9,000				DONATION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2013

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) SCHOLARSHIPS	43	100,000

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

THE GOVERNING BOARD AND MANAGEMENT DEVELOP PROGRAMS WHICH ENHANCE THE CHARITABLE MISSION OF THE ORGANIZATION. DISBURSEMENT FOR GRANTS OR ASSISTANCE FOR THESE PROGRAMS ARE MADE IN ACCORDANCE WITH PRESCRIBED PROCEDURES AND ARE SUBJECT TO CONDITIONS ESTABLISHED BY THE ORGANIZATION'S GOVERNING BOARD AND MANAGEMENT, WHICH ARE DESIGNED TO ENSURE THAT INDIVIDUALS AND ORGANIZATIONS RECEIVING GRANTS OR ASSISTANCE ARE ADEQUATELY INVESTIGATED TO ENSURE THAT THEY ARE QUALIFIED RECIPIENTS.

Schedule I (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)DAVID KAPASKA DOPRESIDENT & CEO	(i) (ii)	0 618,552	0 0	0 177,764	0 13,475	0 19,960	0 829,751	0 0
(2)AMY KRIE MDBOARD TRUSTEE	(i) (ii)	745,469 0	0 0	1,291 0	20,700 0	1,206 0	768,666 0	0 0
(3)KIM PEDERSON MDBOARD TRUSTEE	(i) (ii)	294,243 0	0 0	4,720 0	20,700 0	16,982 0	336,645 0	0 0
(4)JULIE N NORTONSEC/TREAS & SRVP FINANCE	(i) (ii)	390,408 0	0 0	1,271 0	20,700 0	25,412 0	437,791 0	0 0
(5)JUDY BLAUWETSR VICE PRESIDENT	(i) (ii)	339,565 0	0 0	7,441 0	15,600 0	13,285 0	375,891 0	0 0
(6)DAVID FLICEKCHIEF ADMINISTRATIVE OFFICER	(i) (ii)	0 385,091	0 0	0 146,543	0 13,475	0 23,011	0 568,120	0 0
(7)STEVE PETERSENAVP-PHARMACY	(i) (ii)	193,237 0	0 0	1,775 0	11,831 0	22,162 0	229,005 0	0 0
(8)MARY LEEDOMAVP-SURGERY	(i) (ii)	178,833 0	0 0	1,553 0	10,829 0	2,406 0	193,621 0	0 0
(9)CURT HOHMANSR VICE PRESIDENT	(i) (ii)	285,073 0	0 0	1,338 0	20,700 0	7,434 0	314,545 0	0 0
(10)KELLY MCCAUL MD ABIM FRCPCHEMATOLOGY, TRANSPLANTATION	(i) (ii)	1,198,881 0	0 0	4,845 0	20,700 0	8,234 0	1,232,660 0	0 0
(11)HENDRICK KLOPPER MDNEUROSURGERY	(i) (ii)	1,242,587 0	0 0	2,515 0	20,700 0	19,223 0	1,285,025 0	0 0
(12)BRIAN KNUTSON MDDERMATOLOGY	(i) (ii)	1,177,664 0	0 0	3,257 0	20,700 0	21,662 0	1,223,283 0	0 0
(13)MICHAEL PUUMALA MDNEUROSURGERY	(i) (ii)	1,214,900 0	0 0	7,000 0	20,700 0	19,662 0	1,262,262 0	0 0
(14)DANIEL TYNAN MDNEUROSURGERY	(i) (ii)	1,212,161 0	0 0	8,718 0	20,700 0	22,162 0	1,263,741 0	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 3:	THE PRESIDENT & CEO'S COMPENSATION IS PAID BY A RELATED ORGANIZATION, AVERA HEALTH. AVERA MCKENNAN RELIED ON THE RELATED ORGANIZATION FOR DETERMINING THE COMPENSATION FOR THE PRESIDENT & CEO USING THE METHODS DESCRIBED IN PART I, LINE 3.

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) HENDRICK KLOPPER MD	HIGHLY COMPENSATED EMPLOYEE	COMMUNITY NEEDS LOAN		X	200,000	54,167		No	Yes		Yes





Total ...... $						54,167

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2013

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MICHAEL BENDER	BOARD MEMBER	216,761	PROPERTY LEASE		No
(2) PHYSICIANS LABORATORY LTD	BOARD MEMBER IS GREATER THAN 5% OWNER	1,815,356	LAB SERVICES - HISTOLOGY		No
(3) VICTORIA PETERSEN	FAMILY OF KEY EMPLOYEE	34,453	EMPLOYEE COMPENSATION		No
(4) ANESTHESIOLOGY ASSOCIATES INC	BOARD MEMBER IS GREATER THAN 5% OWNER	750,334	PAIN MANGEMENT SERVICES		No
(5) SIOUX FALLS CONSTRUCTION CO	BOARD MEMBER IS AN OFFICER OF THE ENTITY	20,858,419	CONSTRUCTION		No
(6) NEUROLOGY ASSOCIATES	BOARD MEMBER IS A GREATER THAN 5% PARTNER IN THE ENTITY	494,498	ER CALL COVERAGE, RENTED SPACE, AND RENTED EQUIPMENT FROM MCKENNAN		No
(7) WOODS FULLER SCHULTZ & SMITH PC	BOARD MEMBER IS AN OFFICER OF THE ENTITY	293,138	LEGAL SERVICES		No
(8) MARLENE SCHROEDER	FAMILY OF BOARD MEMBER	32,794	EMPLOYEE COMPENSATION		No
(9) JESS CARLSON	FAMILY OF BOARD MEMBER	131,466	EMPLOYEE COMPENSATION		No
(10) CHRISTIANE MAROUN	FAMILY OF BOARD MEMBER	138,441	EMPLOYEE COMPENSATION		No
(11) VINCENTA ROSSING	FAMILY OF BOARD MEMBER	11,585	EMPLOYEE COMPENSATION		No
(12) MATTHEW LEEDOM	FAMILY OF KEY EMPLOYEE	24,586	EMPLOYEE COMPENSATION		No
(13) SARAH KAPPEL	FAMILY OF KEY EMPLOYEE	27,926	EMPLOYEE COMPENSATION		No
(14) KATHERINE SMIDT	FAMILY OF BOARD MEMBER	136,748	EMPLOYEE COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Return Reference	Explanation
FORM 990, PART III, LINE 4A	INFORMATION AND ASSISTANCE: AVERA MCKENNAN OPERATES A 24-HOUR MEDICAL CALL CENTER, THROUGH WHICH PATIENTS HAVE ACCESS TO THE ASK-A-NURSE PROGRAM. PATIENTS CAN CALL A TOLL-FREE NUMBER AND TALK PERSONALLY WITH A REGISTERED NURSE TO ASK HEALTH QUESTIONS OR RECEIVE GENERAL HEALTH INFORMATION. IN 2014, THE MEDICAL CALL CENTER HANDLED 131,053 CALLS. AVERA MCKENNAN'S WEB SITE ALSO PROVIDES AN EXTENSIVE HEALTH LIBRARY THAT CONSUMERS CAN ACCESS FREE OF CHARGE. INTERPRETER SERVICE: AVERA MCKENNAN EMPLOYS TWO FULL-TIME SPANISH INTERPRETERS IN-HOUSE, AND THEIR SERVICES ARE OFFERED TO PATIENTS FREE OF CHARGE. IN ADDITION, IN COOPERATION WITH EXTERNAL AGENCIES, AVERA MCKENNAN IS ABLE TO HANDLE 210 DIFFERENT LANGUAGES AND DIALECTS THROUGH PHONE, VIDEO REMOTE INTERPRETING AND OTHER MEANS. INTERPRETATION SERVICES ARE AVAILABLE FOR PATIENTS WHEN THEY ARE AT AVERA MCKENNAN IN PERSON, OR WHEN THEY CALL BY PHONE. ALL THE ABOVE SERVICES ARE PROVIDED AT NO COST TO THE PATIENT. PRENATAL AND DELIVERY CARE: BECAUSE EARLY AND REGULAR PRENATAL CARE IS IMPORTANT TO PREVENT PREMATURE BIRTH, AVERA MCKENNAN COLLABORATES IN A COMMUNITY EFFORT TO PROVIDE OBSTETRICS CARE FOR WOMEN WHO DO NOT QUALIFY FOR MEDICAID, BUT CANNOT AFFORD HEALTH INSURANCE. THE PROGRAM OFFERS PRENATAL CARE, AND HOSPITAL LABOR AND DELIVERY SERVES FOR A LOW FEE OF $1,000. WOMEN RECEIVE CARE WHETHER THEY CAN COVER ANY OR ALL OF THE FEE. CARE IS PROVIDED PRIMARILY BY FIRST-YEAR FAMILY PRACTICE RESIDENTS, SUPERVISED BY EXPERIENCED PHYSICIANS. THROUGH THIS PROGRAM IN 2014, AVERA MCKENNAN ASSISTED WITH 77 BIRTHS AND PROVIDED 756 PRENATAL AND POST-PARTUM VISITS. TRANSPORT TO TRANSPLANT: AVERA MCKENNAN DEVELOPED THE TRANSPORT TO TRANSPLANT PROJECT, WHICH REMOVES TRANSPORTATION BARRIERS FOR PATIENTS FROM RURAL AREAS WHICH MAY PREVENT THEM FROM COMPLETING THE EVALUATION AND TESTING NEEDED FOR KIDNEY AND/OR PANCREAS TRANSPLANT. A VAN FUNDED THROUGH A GRANT FROM THE AVERA MCKENNAN FOUNDATION IS USED TO TRANSPORT PATIENTS WHO DEMONSTRATE A FINANCIAL NEED. PATIENTS ARE BROUGHT TO THE AVERA TRANSPLANT INSTITUTE FOR A CONDENSED MULTI-DAY EVALUATION WITH ALL TESTING AND VISITS COMPLETED IN LESS THAN ONE WEEK. ULTIMATELY, THE PROJECT RESULTS IN IMPROVED MORBIDITY AND MORTALITY, AS KIDNEY TRANSPLANT DOUBLES PATIENT SURVIVAL AS COMPARED TO REMAINING ON DIALYSIS. AVERA FAMILY WELLNESS: THIS PROGRAM COMBINES POSITIVE ACTIVITIES LIKE VIOLIN LESSONS WITH FAMILY COACHING AT NO CHARGE FOR CHILDREN IN EARLY CHILDHOOD PROGRAMS IN THE SIOUX FALLS SCHOOL DISTRICT. THE GOAL IS TO PREVENT OR LESSEN THE EFFECTS OF BEHAVIORAL HEALTH CONDITIONS ON CHILDREN AND FAMILIES BY FOSTERING A POSITIVE ENVIRONMENT. OVER 450 STUDENTS AND THEIR FAMILIES ARE ENROLLED. THE WALSH FAMILY VILLAGE: THIS HOSPITALITY HOUSE COMPLEX ADJACENT TO THE AVERA MCKENNAN CAMPUS PROVIDES A HOME AWAY FROM HOME FOR PATIENTS AND THEIR FAMILIES WHO COME FOR CARE AT AVERA MCKENNAN FROM OUTSIDE OF SIOUX FALLS. THE PROJECT WAS FUNDED BY DONATIONS AND IS OPERATED BY AVERA MCKENNAN. ELEVEN GUEST ROOMS ARE AVAILABLE. AVERA MCKENNAN ALSO DONATES USE OF A BUILDING IN THE COMPLEX FOR A RONALD MCDONALD HOUSE FOR FAMILIES OF PEDIATRIC PATIENTS. IF THEY CAN AFFORD IT, GUESTS ARE CHARGED A LOW FEE OF $55 PER NIGHT. GUESTS ARE NOT TURNED AWAY DUE TO INABILITY TO PAY THE FEE. EMPLOYEES REGULARLY DONATE NON-PERISHABLE FOOD ITEMS TO STOCK A FOOD PANTRY FOR GUESTS. IN FY2014, THE WALSH FAMILY VILLAGE SERVED 6,988 GUESTS, STAYING IN 4,015 NIGHTLY ROOMS A 90 PERCENT OCCUPANCY. AVERA MCKENNAN PROVIDES A SUBSIDY OF APPROXIMATELY $192,000 PER YEAR TO OPERATE THE HOSPITALITY COMPLEX. PREVENTION AND SUPPORT OF SUBSTANCE USE DISORDER: AVERA MCKENNAN IS A PARTNER WITH FACE IT TOGETHER SIOUX FALLS, A NONPROFIT ORGANIZATION WHICH SERVES AS THE LOCAL FACE AND VOICE FOR RECOVERY FROM ADDICTION THROUGH ITS RECOVERY SUPPORT SERVICES, ADVOCACY AND AWARENESS PROGRAMS. AVERA HAS BEEN A PARTNER WITH FACE IT TOGETHER SINCE ITS INCEPTION, AND IN A RECENT AWARENESS CAMPAIGN. COMMUNITY CONNECTIONS: AVERA MCKENNAN REACHES OUT TO PEOPLE AND COMMUNITIES THROUGHOUT EASTERN SOUTH DAKOTA, SOUTHWESTERN MINNESOTA AND NORTHWEST IOWA THROUGH HOME TOWN CONNECTIONS. PROVIDING A CRITICAL FEEDBACK LINK TO LOCAL REFERRING DOCTORS, THIS PROGRAM COMPLETES THE COMMUNICATIONS LINKS NECESSARY TO KEEP LOCAL HEALTH CARE PROVIDERS CURRENT ON THE TREATMENT OF THEIR PATIENTS AT AVERA MCKENNAN. SUPPORT OF THE ARTS AND CULTURAL LIFE: AVERA MCKENNAN HOSTS SIOUX FALLS' ONLY INDOOR SCULPTUREWALK, AN EXTENSION OF THE COMMUNITY'S DOWNTOWN SCULPTUREWALK. ARTISTS DONATE SCULPTURES FOR ONE YEAR, WHICH ARE PLACED AT LOCATIONS THROUGHOUT AVERA MCKENNAN'S CAMPUS, IN BUILDINGS CONNECTED BY SKYWALKS. BROCHURES CONTAIN A MAP, AND VISITORS WHO FOLLOW THE ROUTE SUGGESTED WALK APPROXIMATELY 1 MILE, MAKING THIS A HEALTHY AS WELL AS A CULTURAL JOURNEY. DIABETES PROGRAMMING: AVERA PARTICIPATES IN A COLLABORATIVE PROJECT WITH SIOUX FALLS PUBLIC SCHOOLS AND THE SOUTH DAKOTA BOARD OF NURSING TO IMPLEMENT ECONSULT SERVICES WITH DIABETIC EDUCATION SPECIALISTS MONITORING MEDICATIONS AND THE HEALTH OF CHILDREN WITH DIABETES IN THE SCHOOL SETTING. AVERA MCKENNAN DIABETES EDUCATORS PROVIDED CLASSES AND ONE-ON-ONE CONSULTATIONS AT A LOSS OF $142,000 IN THE PAST FISCAL YEAR. COMMUNITY BENEFITS: AVERA MCKENNAN PROVIDES ADDITIONAL COMMUNITY BENEFITS INCLUDING: SUPPORT OF YOUTH PROGRAMS; HOMELESS PROGRAMS; COMMUNITY ARTS PROGRAMMING; HEALTH PREVENTION; AWARENESS AND EDUCATION ABOUT CANCER, HEART DISEASE AND OTHER CONDITIONS; AND SUPPORT OF THE SIOUX EMPIRE UNITED WAY AND OTHER SERVICES IN THE REGION. PRESCHOOL VISION AND HEARING SCREENING: AVERA MCKENNAN PROVIDED FREE SCREENING FOR 383 PRESCHOOL CHILDREN IN FISCAL YEAR 2014.
FORM 990, PART VI, SECTION A, LINE 2	GENE JONES JR., CINDY WALSH, AND FRED THURMAN HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE ORGANIZATION IS AVERA HEALTH, A NONPROFIT CORPORATION ORGANIZED AND EXISTING UNDER THE LAWS OF THE STATE OF SOUTH DAKOTA AND EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED.
FORM 990, PART VI, SECTION A, LINE 7A	AVERA HEALTH, AS THE SOLE MEMBER, HAS THE POWER TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, ALL MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	AVERA HEALTH HAS THE FOLLOWING RIGHTS AS THE MEMBER: 1) TO APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE STATEMENTS OF PHILOSOPHY, MISSION AND VALUES OF CORPORATION; 2) TO INITIATE THE ADOPTION, AMENDMENT OR REPEAL OF ANY PROVISION OF THE ARTICLES OF INCORPORATION OR BYLAWS OF CORPORATION, AND TO GIVE FINAL APPROVAL OF ANY SUCH ACTION WITH RESPECT THERETO; 3) TO APPROVE AND ACT UPON THE ALIENATION OF REAL PROPERTY AND PRECIOUS ARTIFACTS UNDER THE CANONICAL STEWARDSHIP OF THE SISTERS OF THE PRESENTATION OF THE BLESSED VIRGIN MARY OF ABERDEEN, SOUTH DAKOTA ("PRESENTATION SISTERS") OR THE BENEDICTINE SISTERS OF SACRED HEART MONASTERY ("BENEDICTINE SISTERS"), PURSUANT TO THE POLICIES ESTABLISHED BY THE MEMBER; 4) TO APPROVE ANY PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION, OR THE DIVESTITURE OF A SPONSORED WORK OR MINISTRY ASSOCIATED WITH THE CORPORATION; 5) TO APPROVE THE CREATION OF NEW SPONSORED WORKS OR MINISTRIES TO BE CONDUCTED BY OR UNDER THE AUTHORITY OF THE CORPORATION; 6) TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE BOARD OF DIRECTORS OF THE CORPORATION. 7) TO APPOINT AND/OR REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION. 8) TO APPROVE OPERATING/CAPITAL BUDGETS AND STRATEGIC PLANS OF THE CORPORATION. 9) TO APPROVE EXPENDITURES OUTSIDE OF OPERATING AND CAPITAL BUDGETS EXCEEDING DEFINED THRESHOLDS ACCORDING TO POLICY WHICH MAY BE ADOPTED FROM TIME TO TIME BY THE MEMBER. 10) TO APPROVE ACQUISITIONS, SALES AND LEASES, ACCORDING TO POLICY WHICH MAY BE ADOPTED FROM TIME TO TIME BY THE MEMBER. 11) TO ESTABLISH AND MAINTAIN EMPLOYEE BENEFIT PROGRAMS. 12) TO ESTABLISH AND MAINTAIN INSURANCE PROGRAMS. 13) TO APPROVE MAJOR COMMUNITY FUND DRIVES. 14) TO APPROVE THE APPOINTMENT OF AUDITORS. 15) TO ADOPT POLICIES DESIGNED TO EFFECTUATE THE RESERVED POWERS OF THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 8B	AVERA MCKENNAN DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 IS REVIEWED BY THE CEO, CFO, AND ASSISTANT VP OF FINANCIAL REPORTING. AFTER THE INITIAL REVIEW, A DRAFT IS PROVIDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW. THE APPROVED RETURN IS PROVIDED TO THE FULL BOARD PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	THE CONFLICT OF INTEREST POLICY COVERS BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. AT EACH BOARD MEETING, A REQUEST IS MADE FOR ALL BOARD MEMBERS TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST PERTAINING TO ANY ITEM LISTED ON THE AGENDA OR PERTAINING TO ANY POTENTIAL ITEM THAT COULD BE DISCUSSED DURING THE COURSE OF THE MEETING. THE DECLARATION OF CONFLICT OF INTEREST IS RECORDED IN THE MEETING MINUTES. THE BOARD MAKES A DETERMINATION OF WHETHER THERE IS A CONFLICT OF INTEREST AND IF SO, IMPLEMENTS THE PROCEDURE FOR EVALUATING THE ISSUE OR TRANSACTION INVOLVED. THE BOARD MEMBER OR OFFICER WITH THE CONFLICT MUST REFRAIN FROM VOTING. A STATEMENT OF CONFLICT OF INTEREST DISCLOSURE IS MADE ON AN ANNUAL BASIS BY OFFICERS AND DIRECTORS. THE INFORMATION IS MAINTAINED IN A DATABASE AND A REPORT IS PROVIDED TO THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15B	THE CEO IS COMPENSATED BY AVERA HEALTH SYSTEM. ANNUALLY THE COMPENSATION COMMITTEE OF AVERA HEALTH, WHICH IS COMPRISED OF SIX (6) SYSTEM MEMBERS APPOINTED BY THE RELIGIOUS ORDERS, MEETS WITH AN INDEPENDENT CONSULTANT REGARDING FAIR MARKET VALUE FOR COMPENSATION OF OFFICERS AND KEY EMPLOYEES. THE COMPENSATION COMMITTEE APPROVES ALL SALARIES BASED ON COMPARABLE DATA AND DOCUMENTS THE BASIS FOR THEIR DECISION IN MEETING MINUTES. THE CFO AND KEY EMPLOYEES ARE COMPENSATED BY AVERA MCKENNAN. ANNUALLY, THE COMPENSATION COMMITTEE OF AVERA MCKENNAN, WHICH IS COMPRISED OF BOARD MEMBERS, MEETS TO REVIEW THE COMPENSATION OF EXECUTIVES AND PHYSICIANS. AVERA MCKENNAN COMPARES ITS COMPENSATION PLAN TO OTHER HEALTHCARE ORGANIZATIONS SIMILAR IN SIZE AND COMPLEXITY TO AVERA MCKENNAN ON A NATIONAL BASIS TO ENSURE COMPENSATION IS COMPARABLE. AVERA MCKENNAN UTILIZES MULTIPLE SALARY SURVEYS AND AN INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE A MARKET ANALYSIS FOR EACH EXECUTIVE'S SUGGESTED PAY OR PAY RANGE. INDIVIDUAL SALARIES REFLECT RELATED EDUCATION AND EXPERIENCE, AS WELL AS THE SCOPE OF THE DUTIES TO ASSURE AMOUNTS PAID ARE REASONABLE.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ATTACHED TO THE FORM 990 PER IRS INSTRUCTIONS AND THEREFORE AVAILABLE TO THE GENERAL PUBLIC.
FORM 990, PART VI, SECTION B, LINE 16B:	THERE IS NO WRITTEN POLICY OR PROCEDURE REQUIRING THE ORGANIZATION TO EVALUATE ITS PARTICIPATION IN JOINT VENTURE ARRANGEMENTS. IN THE EVENT OF ANY SUCH PROPOSED TRANSACTION THE BOARD, OR A COMMITTEE WITH DELEGATED AUTHORITY, REVIEWS ALL MATERIALS, VALUATIONS, AND OPERATIONAL ASPECTS FOR ANY PROPOSED TRANSACTION. SUCH TRANSACTION WOULD BE EVALUATED IN ACCORDANCE WITH THE EXEMPT STATUS OF THE ORGANIZATION AND ITS APPLICABLE PURPOSES. ANY TRANSACTION ALSO MUST BE APPROVED BY THE BOARD AND THE MEMBER.
FORM 990, PART IX, LINE 11G	MEDICAL FEES: PROGRAM SERVICE EXPENSES 9,707,645. MANAGEMENT AND GENERAL EXPENSES 166,678. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,874,323. FFS OTHER: PROGRAM SERVICE EXPENSES 47,772,595. MANAGEMENT AND GENERAL EXPENSES 54,982,928. FUNDRAISING EXPENSES 2,596. TOTAL EXPENSES 102,758,119.
FORM 990, PART X, LINE 20:	THE ISSUE PRICE INCLUDES THE FILING ORGANIZATION'S SHARE OF THE ENTIRE BOND ISSUE, WHICH WAS ISSUED TO AVERA HEALTH ON BEHALF OF THE AVERA OBLIGATED GROUP. THE AVERA OBLIGATED GROUP CONSISTS OF AVERA HEALTH, AVERA MCKENNAN, AVERA ST. LUKE'S, AVERA QUEEN OF PEACE, AVERA SACRED HEART, AVERA ST. MARY'S AND AVERA MARSHALL. IN ACCORDANCE WITH IRS INSTRUCTIONS, INFORMATION RELATED TO THE TAX EXEMPT BOND REPORTING IS BEING REPORTED ON AVERA HEALTH'S TAX RETURN (EIN 46-0422673).
FORM 990, PART XI, LINE 9:	EQUITY TRANSFERS, NET 2,334,050. OTHER CHANGES IN UNRESTRICTED NET ASSETS 101,538.
FORM 990, PART XII, LINE 2C:	THE AUDIT COMMITTEE OF AVERA HEALTH, THE PARENT ORGANIZATION OF AVERA MCKENNAN, SELECTS THE AUDITOR AND REVIEWS THE AUDITED FINANCIAL STATEMENTS FOR AVERA MCKENNAN. ALSO, THE FINANCE COMMITTEE AT AVERA MCKENNAN TAKES RESPONSIBILITY FOR REVIEWING THE AUDITED FINANCIAL STATEMENTS.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

AVERA MCKENNAN

Employer identification number

46-0224743

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) SIOUX FALLS HOSPITAL MANAGEMENT LLC 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS,SD571175045 56-2141521	MANAGEMENT COMPANY OF HEART HOSPITAL	NC	4,559,685	18,638,127	WEST 69TH STREET LLC
(2) WEST 69TH STREET LLC 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS,SD571175045 46-0224743	HOLDING COMPANY	SD	4,559,685	18,638,127	AVERA MCKENNAN
(3) ALUMEND LLC 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS,SD571175045 46-0224743	RESEARCH AND DEVELOPMENT	SD	-1,857,275	1,727,627	AVERA MCKENNAN
(4) MRIS LLC 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS,SD571175045 47-0874983	HEALTHCARE SERVICES	SD	0	0	AVERA MCKENNAN

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) AVERA ST ANTHONY'S HOSPITAL 300 N 2ND STREET ONEILL,NE68763 47-0463911	HEALTHCARE SERVICES	NE	501(C)(3)	LINE 3	AVERA HEALTH		No
(2) AVERA HOLY FAMILY 826 NORTH 8TH STREET ESTHERVILLE,IA51334 42-0680370	HEALTHCARE SERVICES	IA	501(C)(3)	LINE 3	AVERA HEALTH		No
(3) AVERA HOLY FAMILY FOUNDATION 826 NORTH 8TH STREET ESTHERVILLE,IA51334 42-1317452	FUNDRAISING	IA	501(C)(3)	LINE 9	AVERA HOLY FAMILY		No
(4) ST BENEDICT HEALTH CENTER 401 WEST GLYNN DRIVE PARKSTON,SD57366 46-0226738	HEALTHCARE SERVICES	SD	501(C)(3)	LINE 3	AVERA HEALTH		No
(5) ST BENEDICT HEALTH CENTER FOUNDATION WEST GLYNN DRIVE PO BOX B PARKSTON,SD57366 46-0458725	SUPPORT HEALTH RELATED SERVICES	SD	501(C)(3)	LINE 11A, I	ST BENEDICT HEALTH CENTER		No
(6) AVERA HEALTH 3900 WEST AVERA DRIVE STE 300 SIOUX FALLS,SD57108 46-0422673	PROMOTION OF HEALTH	SD	501(C)(3)	LINE 9	N/A		No
(7) AVERA QUEEN OF PEACE 525 NORTH FOSTER MITCHELL,SD57301 46-0224604	HEALTHCARE SERVICES	SD	501(C)(3)	LINE 3	AVERA HEALTH		No
(8) SACRED HEART HEALTH SERVICES 501 SUMMIT STREET YANKTON,SD57078 46-0225483	HEALTHCARE SERVICES	SD	501(C)(3)	LINE 3	AVERA HEALTH		No
(9) AVERA GETTYSBURG 606 EAST GARFIELD GETTYSBURG,SD57442 46-0234354	HEALTHCARE SERVICES	SD	501(C)(3)	LINE 3	AVERA ST MARY'S		No
(10) AVERA AT HOME 5116 S SOLBERG AVE SIOUX FALLS,SD57108 46-0399291	HOME SERVICES	SD	501(C)(3)	LINE 9	AVERA HEALTH		No
(11) LEWIS AND CLARK HEALTH EDUCATION AND SERVICE AGENCY 1000 W 4TH STREET SUITE 9 YANKTON,SD57078 46-0337013	HEALTHCARE EDUCATION	SD	501(C)(3)	LINE 9	SACRED HEART HEALTH SERVICES		No
(12) AVERA ST LUKE'S 305 SOUTH STATE STREET ABERDEEN,SD57401 46-0224598	HEALTHCARE SERVICES	SD	501(C)(3)	LINE 3	AVERA HEALTH		No
(13) AVERA ST MARY'S 801 EAST SIOUX AVENUE PIERRE,SD57501 46-0230199	HEALTHCARE SERVICES	SD	501(C)(3)	LINE 3	AVERA HEALTH		No
(14) AVERA MARSHALL 300 S BRUCE STREET MARSHALL,MN56258 41-0919153	HEALTHCARE SERVICES	MN	501(C)(3)	LINE 3	AVERA HEALTH		No
(15) AVERA MARSHALL FOUNDATION 300 SOUTH BRUCE STREET MARSHALL,MN56258 41-1784801	FUNDRAISING	MN	501(C)(3)	LINE 7	AVERA MARSHALL		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) AVERA HOME MEDICAL EQUIPMENT LLC 1325 S CLIFF AVE PO BOX 5045 SIOUX FALLS,SD57117 46-0488198	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA MCKENNAN	RELATED	204,398	4,802,540	Yes		21,532	Yes		78.720 %
(2) HOME MEDICAL EQUIPMENT OF PIERRE LLC 329 E DAKOTA PIERRE,SD57501 46-0444002	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA MCKENNAN	RELATED	62,940	235,822		No	16,841	Yes		50.000 %
(3) AVERA HOME MEDICAL EQUIPMENT OF FLOYD VALLEY HOSPITAL LLC 714 LINCOLN ST NE LEMARS,IA51031 82-0582350	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA HOME MEDICAL EQUIPMENT LLC	RELATED	18,172	85,478	Yes		4,127	Yes		39.320 %
(4) AVERA HOME MEDICAL EQUIPMENT OF ESTHERVILLE LLC PO BOX 5045 SIOUX FALLS,SD57117 20-1686097	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA HOME MEDICAL EQUIPMENT LLC	RELATED	-4,189	129,303	Yes		-1,113	Yes		39.320 %
(5) AVERA HOME MEDICAL EQUIPMENT OF SIOUX CENTER LLC 38 19TH ST SW SIOUX CENTER,IA51250 75-3203100	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA HOME MEDICAL EQUIPMENT LLC	RELATED	21,538	106,787	Yes		6,342	Yes		39.320 %
(6) AVERA HOME MEDICAL EQUIPMENT OF MARSHALL LLC 1104 EAST COLLEGE DRIVE MARSHALL,MN56258 20-5271924	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA HOME MEDICAL EQUIPMENT LLC	RELATED	67,785	299,291	Yes		21,677	Yes		39.320 %
(7) Q&M PROPERTIES LLC 525 NORTH FOSTER MITCHELL,SD57301 73-1652049	MEDICAL CLINIC BUILDING	SD	AVERA QUEEN OF PEACE	RELATED	-498	381,176		No			No	50.000 %
(8) SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC 310 S PENNSYLVANIA ST ABERDEEN,SD57401 46-0461429	SURGICAL ASSOCIATES	SD	N/A
(9) AVERA HME OF SPENCER HOSPITAL LLC 2400 S MINNESOTA AVENUE 102 SIOUX FALLS,SD57117 80-0619999	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA HOME MEDICAL EQUIPMENT LLC	RELATED	-14,774	99,425	Yes		-6,890	Yes		39.330 %
(10) HEART HOSPITAL OF SOUTH DAKOTA LLC 4500 W 69TH STREET SIOUX FALLS,SD57108 56-2143771	HEALTHCARE SERVICES	SD	AVERA MCKENNAN	RELATED	9,119,369	37,276,253		No			No	66.670 %
(11) BROOKINGS HEALTH SYSTEM - AVERA HME LLC 101 22ND AVE SUITE 101 BROOKINGS,SD57006 45-3204123	MEDICAL SERVICES - HOME MEDICAL EQUIPMENT	SD	AVERA HOME MEDICAL EQUIPMENT LLC	RELATED	46,054	188,377	Yes		10,959		No	39.320 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) ACCOUNTS MANAGEMENT INC 5132 S CLIFF AVE SUITE 101 SIOUX FALLS,SD57108 46-0373021	COLLECTION AGENCY	SD	N/A	C				No
(2) AVERA HEALTH PLANS INC 3900 WEST AVERA DRIVE SUITE 101 SIOUX FALLS,SD57108 46-0451539	HEALTH FINANCING AND HEALTH PLAN ADMINISTRATION	SD	N/A	C				No
(3) AVERA PROPERTY INSURANCE INC 610 W 23RD ST STE 1 PO BOX 38 YANKTON,SD57078 46-0463155	INSURANCE	SD	N/A	C				No
(4) VALLEY HEALTH SERVICES 501 SUMMIT STREET YANKTON,SD57078 46-0357149	RENTAL REAL ESTATE	SD	N/A	C				No

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) AVERA HOME MEDICAL EQUIPMENT LLC	A	266,580	INTERCOMPANY DETAIL FROM GL
(2) AVERA HOME MEDICAL EQUIPMENT LLC	L	138,987	INTERCOMPANY DETAIL FROM GL
(3) AVERA HOME MEDICAL EQUIPMENT LLC	Q	5,769,199	INTERCOMPANY DETAIL FROM GL
(4) AVERA HOME MEDICAL EQUIPMENT LLC	R	5,992,962	INTERCOMPANY DETAIL FROM GL
(5) AVERA HEART HOSPITAL OF SOUTH DAKOTA LLC	R	1,905,813	INTERCOMPANY DETAIL FROM GL
(6) AVERA HEART HOSPITAL OF SOUTH DAKOTA LLC	S	9,386,588	INTERCOMPANY DETAIL FROM GL
(7) AVERA HEART HOSPITAL OF SOUTH DAKOTA LLC	L	1,898,771	INTERCOMPANY DETAIL FROM GL
(8) AVERA HEART HOSPITAL OF SOUTH DAKOTA LLC	Q	651,581	INTERCOMPANY DETAIL FROM GL
(9) AVERA ST LUKE'S	M	161,281	INTERCOMPANY DETAIL FROM GL
(10) AVERA SACRED HEART	M	55,380	INTERCOMPANY DETAIL FROM GL
(11) AVERA QUEEN OF PEACE	M	64,211	INTERCOMPANY DETAIL FROM GL
(12) AVERA MARSHALL	M	66,045	INTERCOMPANY DETAIL FROM GL
(13) AVERA QUEEN OF PEACE	L	851,368	INTERCOMPANY DETAIL FROM GL
(14) AVERA QUEEN OF PEACE	A	270,166	INTERCOMPANY DETAIL FROM GL
(15) AVERA MARSHALL	L	2,549,598	INTERCOMPANY DETAIL FROM GL
(16) AVERA MARSHALL	R	186,963	INTERCOMPANY DETAIL FROM GL
(17) AVERA SACRED HEART	L	957,426	INTERCOMPANY DETAIL FROM GL
(18) AVERA ST LUKE'S	L	752,812	INTERCOMPANY DETAIL FROM GL

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation
FORM 990, SCHEDULE R, PART V, LINE 2, COLUMN C	THE AMOUNTS REPORTED IN COLUMN C ARE REPORTED BASED ON A REVIEW OF GENERAL LEDGER ACTIVITY IN INTERCOMPANY ACCOUNTS, AND REVIEW OF EQUITY ACCOUNTS FOR CONTRIBUTIONS AND DISTRIBUTIONS.

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PROMOTION OF HEALTH
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	7,087
6	Total number of volunteers (estimate if necessary) .............	6	1,141
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	6,821,725
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	1,528,761

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,708,700	5,749,535
9	Program service revenue (Part VIII, line 2g) .........	747,902,697	794,241,246
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	4,006,242	7,455,162
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,900,322	1,814,295
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	757,517,961	809,260,238
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	3,822,676	3,863,251
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	402,340,146	398,578,352
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	65,630
b	Total fundraising expenses (Part IX, column (D), line 25) 807,603
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	326,008,484	364,453,303
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	732,171,306	766,960,536
19	Revenue less expenses. Subtract line 18 from line 12.......	25,346,655	42,299,702
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	827,983,677	901,188,095
21	Total liabilities (Part X, line 26).............	342,106,191	350,186,666
22	Net assets or fund balances. Subtract line 21 from line 20.....	485,877,486	551,001,429

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 371,847,328 including grants of $ 3,793,158 ) (Revenue $ 522,642,583 )
	AVERA MCKENNAN HOSPITAL & UNIVERSITY HEALTH CENTERAVERA MCKENNAN PROMOTES THE HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF CHARITABLE HEALTH CARE SERVICES. AVERA MCKENNAN OPERATES UNDER THE TENETS OF THE ROMAN CATHOLIC CHURCH AND IN ACCORDANCE WITH THE PHILOSOPHY AND VALUES ESTABLISHED FOR AVERA HEALTH, A SPONSORED MINISTRY OF THE BENEDICTINE AND PRESENTATION SISTERS.MAJOR SERVICE LINES INCLUDE ONCOLOGY, SURGERY, OBSTETRICS, PEDIATRICS, NEONATOLOGY, EMERGENCY AND TRAUMA, CRITICAL CARE INCLUDING EICU, RADIOLOGY AND DIAGNOSTIC IMAGING, PSYCHIATRY, PULMONARY, ORTHOPEDICS, NEUROLOGY, CARDIOLOGY AND GASTROENTEROLOGY. TRANSPLANT SERVICES INCLUDE SOLID ORGAN (KIDNEY AND PANCREAS) AND BONE MARROW TRANSPLANT.THE FOLLOWING ARE SPECIFIC EXEMPT PURPOSE ACHIEVEMENTS FOR AVERA MCKENNAN HOSPITAL:CHARITY AND UNCOMPENSATED CARE: AVERA MCKENNAN PROVIDES NECESSARY MEDICAL SERVICES (DIAGNOSTIC AND TREATMENT) FOR WHOMEVER COMES TO US FOR CARE, REGARDLESS OF THEIR ABILITY TO PAY. IN FISCAL YEAR 2014, SERVICES PROVIDED TO THOSE WHO ARE UNABLE TO PAY TOTALED $38,609,000.ELIGIBILITY FOR DISCOUNTED OR FREE SERVICES UNDER THE CHARITY CARE POLICY IS BASED ON INCOME LEVELS. GENERALLY, INDIVIDUALS EARNING INCOME OF UP TO 400% OF THE FEDERAL POLICY INCOME GUIDELINES ARE ELIGIBLE FOR VARYING LEVELS OF DISCOUNTS, INCLUDING FULL DISCOUNTS FOR CERTAIN INCOME LEVELS. APPLICATION FOR COVERAGE UNDER THE PROGRAM MAY BE OBTAINED AT ANY AVERA MCKENNAN PATIENT REGISTRATION AREA OR BY CALLING AVERA MCKENNAN PATIENT FINANCIAL SERVICES.AVERA MCKENNAN HELPS PATIENTS APPLY FOR ANY APPLICABLE GOVERNMENT INSURANCE PROGRAMS, AND OFFERS HEALTH CARE SERVICES ON A DISCOUNTED OR CHARITABLE BASIS TO THOSE WHO ARE UNINSURED OR UNDERINSURED. CHARITY CARE IS NOT CAPPED BY A BUDGET FIGURE UNREIMBURSED EXPENSES ARE COVERED BY THE ORGANIZATION AS NEEDED, NOT UNTIL A BUDGET FIGURE IS MET.IN ADDITION TO CHARITY CARE, IN THE PAST FISCAL YEAR AVERA MCKENNAN PROVIDED $194,739 IN LODGING, TRANSPORTATION AND PRESCRIPTIONS TO THOSE IN NEED.ACCESSIBILITY TO HEALTH CARE: AVERA MCKENNAN MAKES MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY IT SERVES. IN 2014 AVERA MCKENNAN HAD 20,800 HOSPITAL DISCHARGES, 109,153 PATIENT DAYS AND 239,785 OUTPATIENT VISITS. AVERA MCKENNAN IS A VERIFIED LEVEL II TRAUMA CENTER AND WAS THE FIRST SUCH CENTER IN THE STATE OF SOUTH DAKOTA. AVERA MCKENNAN'S EMERGENCY DEPARTMENT IS STAFFED 24 HOURS A DAY WITH BOARD-CERTIFIED EMERGENCY SPECIALISTS AND PROVIDES EMERGENCY CARE REGARDLESS OF ABILITY TO PAY. AVERA MCKENNAN HAD 27,363 EMERGENCY DEPARTMENT VISITS IN FY 2014. OPERATING BOTH FIXED WING AND HELICOPTER MEDICAL AIR TRANSPORTS, AVERA MCKENNAN'S FLIGHT TEAMS COVER A LARGE GEOGRAPHIC AREA PROVIDING STATE-OF-THE-ART AIR TRANSPORT SERVICES AND ACCESS TO CRITICAL CARE, WITH 1,489 FLIGHTS IN THE PAST YEAR.HEALTH CARE CLINIC: IN 1992, AVERA MCKENNAN ESTABLISHED A HEALTH CARE CLINIC TO PROVIDE FREE CARE FOR PEOPLE WHO ARE UNINSURED OR UNDERINSURED IN THE COMMUNITY. THE CLINIC IS MANAGED BY A REGISTERED NURSE AND STAFFED BY REGISTERED NURSES, TWO MIDLEVEL PROVIDERS, MEDICAL RESIDENTS AND VOLUNTEER HEALTH CARE PROVIDERS. THE GOAL OF THE CLINIC IS TO PREVENT OR TREAT PATIENTS' MEDICAL CONDITIONS BEFORE THEY BECOME CATASTROPHIC. THE CLINIC AVERAGES 550 VISITS PER MONTH, PROVIDING PREVENTATIVE CARE, DIAGNOSIS AND TREATMENT OF ILLNESSES AND INJURIES, MEDICATION ASSISTANCE AND ASSISTANCE IN OBTAINING SPECIALIST CARE FOR PATIENTS WITH COMPLEX CASES. THE CLINIC ALSO SERVES TO TRAIN PHYSICIANS, NURSES AND OTHER HEALTH CARE STUDENTS. IT PROVIDES A FREE EVENING CLINIC ONE EVENING PER MONTH, STAFFED BY MEDICAL STUDENTS UNDER SUPERVISION OF PHYSICIANS. AVERA MCKENNAN IS THE ONLY HEALTH CARE ORGANIZATION TO PROVIDE FREE SERVICES SUCH AS THIS IN THE STATE OF SOUTH DAKOTA. THE CLINIC HAD 6,549 VISITS IN 2014, AND WAS OPERATED AT AN ANNUAL COST OF $964,435. AVERA MCKENNAN PARTNERS WITH THE NOT-FOR-PROFIT DESTINY CLINIC BY PROVIDING FUNDING OF $15,000 PER YEAR TO PROVIDE FREE EVENING CLINIC SERVICES.PARTNERSHIP IN LIVE WELL SIOUX FALLS: THE CITY OF SIOUX FALLS RECEIVED A COMMUNITY HEALTH TRANSFORMATION GRANT FROM THE SOUTH DAKOTA DEPARTMENT OF HEALTH, SPARKING A PROJECT TO IMPROVE THE HEALTH AND WELL-BEING OF THE CITIZENS OF SIOUX FALLS. GUIDED BY THE CITY OF SIOUX FALLS HEALTH DEPARTMENT, THIS ONGOING PROJECT IS KNOWN AS LIVE WELL SIOUX FALLS. IT INVOLVES MORE THAN 24 COMMUNITY PARTNER ORGANIZATIONS. AMONG THESE PARTNERS ARE AVERA MCKENNAN AND THE OTHER MAJOR HEALTH CARE SYSTEM IN SIOUX FALLS, SANFORD HEALTH. AVERA PLANS TO WORK IN PARTNERSHIP WITH THE CITY OF SIOUX FALLS AND SANFORD HEALTH TO ADDRESS THE PRIORITIES OF LIVE WELL SIOUX FALLS, AND ARRIVE AT SOLUTIONS WHICH ARE COLLABORATIVE IN NATURE.AVERA MCKENNAN COLLABORATES WITH LIVE WELL SIOUX FALLS TO PROMOTE THE BIG SQUEEZE, A HYPERTENSION INITIATIVE IN APRIL TO PROMOTE BLOOD PRESSURE SCREENING AND EDUCATION, WITH THE GOAL OF DIAGNOSING HIGH BLOOD PRESSURE. ONE IN THREE AMERICAN ADULTS HAVE HIGH BLOOD PRESSURE, BUT ONLY HALF OF THEM HAVE IT UNDER CONTROL, ADDING TO THE RISK OF STROKE, HEART ATTACK AND VASCULAR DISEASE.RESIDENCY/HEALTH PROFESSIONS TRAINING AND INTERNSHIPS: IN 2014, AVERA MCKENNAN HAD 88 MEDICAL SCHOOL RESIDENTS IN TRAINING AT AVERA MCKENNAN IN INTERNAL MEDICINE, FAMILY PRACTICE, PSYCHIATRY, GERIATRICS AND TRANSITIONAL RESIDENCY PROGRAMS OFFERED IN PARTNERSHIP WITH THE UNIVERSITY OF SOUTH DAKOTA SCHOOL OF MEDICINE. OVER 800 STUDENTS IN NURSING, PHARMACY, PHYSICIAN ASSISTANT PROGRAMS, RADIOLOGY AND RESPIRATORY THERAPY ALSO COMPLETED ROTATIONS AT AVERA MCKENNAN. AVERA MCKENNAN HAS MANY JOINT AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION FOR BOTH CLINICAL AND EDUCATIONAL PROGRAMMING. IN NON-CLINICAL AREAS, AVERA MCKENNAN OFFERED 98 PAID AND UNPAID INTERNSHIPS IN 2014 IN THE AREAS OF MARKETING, HUMAN RESOURCES, FINANCE, FOUNDATION, AND NETWORK OPERATIONS. AVERA MCKENNAN IS CURRENTLY AFFILIATED WITH APPROXIMATELY 90 INSTITUTIONS OF HIGHER EDUCATION.PATIENT AND COMMUNITY EDUCATION: AVERA MCKENNAN IS A REGIONAL LEADER IN OFFERING EDUCATIONAL PROGRAMS FOR A VARIETY OF LEARNERS, LEADERS AND EMPLOYEES. UTILIZING ADVANCED TECHNOLOGY, MANY OF THESE PROGRAMS ARE PROVIDED ELECTRONICALLY THROUGHOUT THE TRI-STATE AREA. EDUCATIONAL SESSIONS ARE OFFERED TO MEDICAL STAFF, EMPLOYEES, HEALTH CARE PROFESSIONALS, STUDENTS AT ALL LEVELS AND THE GENERAL PUBLIC. UTILIZING AVERA MCKENNAN'S EDUCATION CENTER, A BROAD CROSS-SECTION OF CLASSES INVOLVING DIVERSE AUDIENCES ARE PROVIDED AS A COMMUNITY SERVICE EACH YEAR.* ONLINE RESOURCES: AVERA MCKENNAN OFFERS VAST FREE PATIENT EDUCATIONAL ONLINE RESOURCES ON ITS PUBLIC WEBSITE ON NUMEROUS HEALTH TOPICS, WITH SUGGESTIONS FOR LIFESTYLE CHANGE, BEHAVIOR MODIFICATION AND MANAGEMENT FOR IMPROVED HEALTH.* TO BE WELL FREE EDUCATION EVENTS WERE HELD ON TOPICS INCLUDING ORTHOPEDICS, CANCER, DIABETES, WEIGHT LOSS/HEALTHY EATING, MULTIPLE SCLEROSIS, ANXIETY AND ACUPUNCTURE. * FORUMS: THE AVERA BEHAVIORAL HEALTH CENTER OFFERS FREE FRIDAY FORUMS, IN WHICH SCHOOL COUNSELORS AND THERAPISTS ARE INVITED TO PRESENTATIONS ON CHILDREN'S MENTAL HEALTH TOPICS SUCH AS CONFLICT CYCLES, REACTIVE ATTACHMENT DISORDER, DEPRESSION AND BIPOLAR DISORDER IN CHILDREN, AND TEEN SUBSTANCE USE, ABUSE AND ADDICTION. THESE SESSIONS, HELD NINE TIMES EACH YEAR, ARE ATTENDED IN PERSON BY APPROXIMATELY 80. THROUGHOUT 2014, VIDEOS OF THESE PRESENTATIONS WERE VIEWED 401 TIMES ONLINE.* THE AVERA BEHAVIORAL HEALTH CENTER OFFERS FREE MONTHLY EDUCATIONAL SESSIONS ON VARIOUS TOPICS FOLLOWED BY DISCUSSION FOR ADULTS WHO HAVE BEEN IMPACTED BY A LOVED ONE'S MENTAL ILLNESS. TOPICS HAVE INCLUDED GRIEF AND LOSS, ANXIETY, AND PARENTING STRATEGIES FOR MANAGING CHALLENGING BEHAVIORS.* WOMEN'S & CHILDREN'S SERVICES: AVERA MCKENNAN'S WOMEN'S & CHILDREN'S SERVICES OFFERS A NUMBER OF PARENTING AND COMMUNITY EDUCATION OPPORTUNITIES, FOR FREE OR AT A MINIMAL COST. IN FISCAL YEAR 2014, 151 CHILDBIRTH EDUCATION CLASSES WERE HELD WITH 593 ATTENDEES. A TOTAL OF 17 PARENT AND FAMILY EDUCATION CLASSES WERE HELD WITH 180 ATTENDEES. A TOTAL OF 64 CAR SEATS WERE ISSUED THROUGH THE SOUTH DAKOTA CHILD SAFETY SEAT DISTRIBUTION PROGRAM. FREE BURN EDUCATION WAS PROVIDED TO 2,931 STUDENTS DURING PRESENTATIONS IN SCHOOLS.* DAYCARE TRAINING: FREE OF CHARGE, AVERA MCKENNAN OFFERS FOUR IN-SERVICE TRAINING SESSIONS PER MONTH TO DAYCARE PROVIDERS THROUGH THE EMBE, WITH A TOTAL OF 36 SCHEDULED ANNUALLY, AND ADDITIONAL SESSIONS FOR REQUESTED TOPICS. SUPPORT GROUPS: AVERA MCKENNAN OFFERS APPROXIMATELY 10 FREE SUPPORT GROUPS. THEY RANGE IN TOPIC FROM CANCER TO LIVER DISEASE, DIABETES, BONE MARROW TRANSPLANT, STROKE AND GRIEF AND LOSS. THE ORGANIZATION PROVIDES FREE MEETING SPACE AS WELL AS SPEAKERS AND LEADERS.

4b	(Code: ) (Expenses $ 41,500,891 including grants of $ 7,996 ) (Revenue $ 52,616,286 )
	RURAL CRITICAL ACCESS HOSPITALSAVERA MCKENNAN OWNS OR LEASES RURAL CRITICAL ACCESS HOSPITALS IN FLANDREAU, GREGORY, DELL RAPIDS, MILBANK AND MILLER (HAND COUNTY), S.D. AS SUCH, THEY OPERATE AS A DEPARTMENT OF AVERA MCKENNAN. THE HOSPITALS IN FLANDREAU, GREGORY AND HAND COUNTY SERVE MEDICALLY UNDERSERVED COUNTIES. IN ADDITION TO THE EXEMPT PURPOSE ACHIEVEMENTS, THE RURAL HOSPITALS PARTICIPATE IN MANY OF THE ACTIVIES DESCRIBED IN PART III, LINE 4A AS PART OF AVERA MCKENNAN.AMONG SERVICES OFFERED BY RURAL HOSPITALS ARE RADIOLOGY AND IMAGING, COLONOSCOPY AND ENDOSCOPY, THERAPY AND REHABILITATION, 24-HOUR EMERGENCY CARE, CHEMOTHERAPY, ORTHOPEDICS, CARDIOVASCULAR TESTING AND CARE, OBSTETRICS, SURGERY, AND DIALYSIS.CHARITY AND UNCOMPENSATED CARE: AS PART OF AVERA MCKENNAN, THESE FACILITIES PROVIDE NECESSARY MEDICAL SERVICES (DIAGNOSTIC AND TREATMENT) FOR WHOMEVER COMES TO US FOR CARE, REGARDLESS OF THEIR ABILITY TO PAY. IN FISCAL YEAR 2014, CHARITY AND UNCOMPENSATED CARE PROVIDED BY RURAL HOSPITALS TOTALED $750,000.ACCESSIBILITY TO HEALTH CARE: AVERA MCKENNAN REGIONAL HOSPITALS MAKE MEDICAL CARE ACCESSIBLE TO THE ENTIRE COMMUNITY THEY SERVE REGARDLESS OF A PATIENT'S ABILITY TO PAY. IN 2014 RURAL HOSPITALS HAD 1,568 DISCHARGES, 6,946 PATIENT DAYS AND 61,706 OUTPATIENT VISITS. EACH OF THE HOSPITALS PROVIDES 24-HOUR EMERGENCY CARE WITH EEMERGENCY SERVICES THROUGH AVERA MCKENNAN. EICU SERVICES ARE ALSO AVAILABLE AT THESE HOSPITALS, PROVIDING ACCESS TO CRITICAL CARE MEDICINE NEAR HOME AND LESSENING THE NEED FOR TRANSPORT. THERE IS NO ADDITIONAL BILLING TO PATIENTS. TELEMEDICINE CONSULTS ARE ALSO OFFERED AT RURAL LOCATIONS IN A NUMBER OF MEDICAL SPECIALTIES.

4c	(Code: ) (Expenses $ 176,702,553 including grants of $ 56,152 ) (Revenue $ 145,122,814 )
	CLINICSAVERA MCKENNAN PROVIDES CLINICAL CARE, SECONDARY AND PRIMARY, IN 90 OWNED/JOINT VENTURE CLINICS IN SOUTH DAKOTA, NORTHWEST IOWA, SOUTHWEST MINNESOTA AND NORTHEASTERN NEBRASKA. IN ADDITION TO THE FOLLOWING EXEMPT PURPOSE ACHIEVEMENTS, CLINICS PARTICIPATE IN MANY OF THE ABOVE AS PART OF AVERA MCKENNAN. CLINIC VISITS IN 2014 TOTALED 1,018,686.CLINICS PROVIDE PRIMARY CARE AND URGENT CARE, AND AMONG SPECIALTIES ARE CARDIOLOGY; DERMATOLOGY; ENDOCRINOLOGY; GASTROENTEROLOGY; HEMATOLOGY; HEPATOLOGY; INFECTIOUS DISEASE; INTERNAL MEDICINE; NEONATOLOGY; NEPHROLOGY; NEUROLOGY AND NEUROSURGERY; OB/GYN; ONCOLOGY; OPHTHALMOLOGY; ORTHOPEDICS; PAIN MANAGEMENT; PEDIATRICS; PSYCHIATRY; PULMONOLOGY; SPORTS MEDICINE; SURGERY; AND VASCULAR SERVICES.CHARITY AND UNCOMPENSATED CARE: AS PART OF AVERA MCKENNAN, CLINICS PROVIDE NECESSARY MEDICAL SERVICES (DIAGNOSTIC AND TREATMENT) FOR WHOEVER COMES TO US FOR CARE, REGARDLESS OF THEIR ABILITY TO PAY. IN FISCAL YEAR 2014, CHARITY AND UNCOMPENSATED CARE PROVIDED BY CLINICS TOTALED $646,000.ACCESSIBILITY TO HEALTH CARE: IN ADDITION TO REGULAR CLINIC HOURS, AVERA MCGREEVY CLINIC PROVIDES URGENT CARE, SEEING PATIENTS ON A WALK-IN BASIS AT TWO LOCATIONS DURING THE EVENING HOURS ON WEEKDAYS, AND THROUGHOUT THE DAYTIME HOURS ON SATURDAYS AND SUNDAYS. THIS PROVIDES GREATER ACCESSIBILITY WITHOUT HAVING TO RELY ON EMERGENCY ROOM CARE. IN ADDITION, THROUGH OUR CURAQUICK CLINIC, AVERA OFFERS CONVENIENT, AFFORDABLE CLINIC CARE IN A LOCAL HYVEE PHARMACY.

	(Code: ) (Expenses $ 53,770,484 including grants of $ 5,945 ) (Revenue $ 74,368,493 )
	AVERA MCKENNAN ALSO PROVIDES LONG-TERM CARE, HOME MEDICAL EQUIPMENT & OTHER RETAIL, HOME INFUSION, RESEARCH, FITNESS CENTER, REGIONAL LAB AND MOBILE SERVICES.MEDICAL RESEARCH: AS A RESEARCH INSTITUTION, AVERA MCKENNAN DRAWS PHYSICIANS WHO ARE COMMITTED TO SEEKING NEW TREATMENTS AND PREVENTIVE MEASURES. THE AVERA RESEARCH INSTITUTE IN 2014 PARTICIPATED IN OVER 90 CLINICAL TRIALS, INVOLVING CANCER, ALZHEIMER'S DISEASE, BEHAVIORAL HEALTH, DIABETES AND MORE. THE AVERA RESEARCH INSTITUTE ALSO CONTINUES ONGOING APPLIED RESEARCH IN THE AREA OF DEVELOPING A NOVEL PHOTOCHEMICAL TISSUE BONDING TECHNOLOGY THAT HAS VASCULAR, OPHTHALMOLOGIC AND DERMATOLOGICAL APPLICATIONS. THROUGH ITS GENETICS LAB, AVERA MCKENNAN IS STUDYING CLINICAL APPLICATIONS OF PERSONALIZED MEDICINE THROUGH PHARMACOGENOMICS IN AREAS OF PAIN MANAGEMENT, BEHAVIORAL HEALTH, CARDIOVASCULAR HEALTH, INTERNAL MEDICINE, AND CANCER. IN FISCAL YEAR 2014, AVERA MCKENNAN OPERATED THE AVERA RESEARCH INSTITUTE AT A LOSS OF $6,912,736.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 53,770,484 including grants of $ 5,945 ) (Revenue $ 74,368,493 )
4e	Total program service expenses643,821,256

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	8,518,745	1,327,950	464,011

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a		50,997
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		1,236,154
e	Government grants (contributions)1e		408,221

f	All other contributions, gifts, grants, and similar amounts not included above1f		4,054,163

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			5,749,535
			Business Code
2a	NET PATIENT SERVICE RE		622110	727,549,429	727,549,429
b	OTHER PATIENT AND CLIN		621500	41,428,068	35,798,598	5,629,470
c	INCOME FROM SUBSIDIARI		423000	10,930,002	10,873,368	56,634
d	MEANINGFUL USE REVENUE		900099	4,817,656	4,817,656
e	INTEREST IN FOUNDATION		900099	2,492,661	2,492,661
f	All other program service revenue .			7,023,430	7,006,589	16,841
g	Total. Add lines 2a–2f........			794,241,246
3	Investment income (including dividends, interest, and other similar amounts).......			14,238			14,238
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	1,420,910
b	Less: rental expenses	1,234,325
c	Rental income or (loss)	186,585
d	Net rental income or (loss).......			186,585			186,585
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7,423,805	17,119
b	Less: cost or other basis and sales expenses	0	0
c	Gain or (loss)	7,423,805	17,119
d	Net gain or (loss)..........			7,440,924			7,440,924
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	COMMERCIAL TESTING		621500	671,445		671,445
b	INTEREST INCOME		900099	508,930	508,930
c	SPORTS PROGRAM		900099	447,335		447,335
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,627,710
12	Total revenue. See Instructions......			809,260,238	789,047,231	6,821,725	7,641,747


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............				1
2	Savings and temporary cash investments .........			25,389,142	2	24,099,954
3	Pledges and grants receivable, net ...........			2,382,202	3	2,286,327
4	Accounts receivable, net .............			93,735,966	4	106,439,778
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5	54,167
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............			3,220,401	7	3,048,041
8	Inventories for sale or use ..............			14,929,302	8	15,633,019
9	Prepaid expenses and deferred charges ..........			10,595,030	9	16,682,059
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	734,763,682
b	Less: accumulated depreciation .....	10b	379,015,317	358,612,850	10c	355,748,365
11	Investments—publicly traded securities ..........			8,554,927	11	9,884,715
12	Investments—other securities. See Part IV, line 11 .....			229,497,375	12	267,843,176
13	Investments—program-related. See Part IV, line 11 .....			11,817,238	13	12,480,826
14	Intangible assets ...............			45,416,755	14	42,906,869
15	Other assets. See Part IV, line 11 ...........			23,832,489	15	44,080,799
16	Total assets. Add lines 1 through 15 (must equal line 34)......			827,983,677	16	901,188,095
17	Accounts payable and accrued expenses .........			69,147,875	17	67,459,728
18	Grants payable .................				18
19	Deferred revenue ................			1,464,257	19	495,769
20	Tax-exempt bond liabilities .............			221,217,723	20	246,486,080
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			823,621	21	835,399
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			17,706,579	23	5,652,057
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			31,746,136	25	29,257,633
26	Total liabilities. Add lines 17 through 25.........			342,106,191	26	350,186,666
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			471,655,159	27	534,600,056
28	Temporarily restricted net assets ...........			11,590,650	28	13,708,584
29	Permanently restricted net assets ...........			2,631,677	29	2,692,789
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			485,877,486	33	551,001,429
34	Total liabilities and net assets/fund balances ........			827,983,677	34	901,188,095